Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
Surg Today. 2023 Sep;53(9):1064-1072. doi: 10.1007/s00595-023-02646-4. Epub 2023 Feb 1.
The prognostic significance of the cachexia index, a novel biomarker of cancer cachexia, remains unclear in colorectal cancer; we, therefore, evaluated this relationship.
This retrospective cohort study included 306 patients with stage I-III colorectal cancer who underwent R0 resection between April 2010 and March 2020. The cachexia index was calculated as (skeletal muscle index [cm/m] × serum albumin level [g/dL])/neutrophil-to-lymphocyte ratio. The overall and disease-free survival rates were analyzed using a Cox proportional hazards model.
A low cachexia index was found in 94 patients. This group had significantly lower disease-free survival and overall survival than the high-cachexia index group (5-year survival, 86.3% vs. 63.1%, p < 0.01; 87.9% vs. 67.2%, p < 0.01). Multivariate analyses showed that T3 or T4 (hazard ratio [HR]: 2.56; 95% confidence interval CI 1.04-6.25, p = 0.039), stage III (HR: 3.77; 95% CI 1.79-7.93, p < 0.01), and a low cachexia index (HR: 2.27; 95% CI 1.31-3.90, p = 0.003) were significant independent predictors of the disease-free survival. CA19-9 ≥ 37.0 ng/mL (HR: 2.68; 95% CI: 1.37-5.24, p = 0.004), stage III (HR: 2.57; 95% CI 1.34-4.92, p = 0.004), and a low cachexia index (HR: 2.35; 95% CI 1.31-4.21, p = 0.004) were significant independent predictors of the overall survival.
A low cachexia index might be a long-term prognostic factor of colorectal cancer.
一种新的癌症恶病质生物标志物——恶病质指数的预后意义在结直肠癌中尚不清楚；因此，我们对此进行了评估。
本回顾性队列研究纳入了 2010 年 4 月至 2020 年 3 月期间接受 R0 切除术的 306 例 I-III 期结直肠癌患者。恶病质指数的计算方法为（骨骼肌指数[cm/m]×血清白蛋白水平[g/dL]）/中性粒细胞与淋巴细胞比值。采用 Cox 比例风险模型分析总生存和无病生存情况。
94 例患者恶病质指数较低。该组无病生存率和总生存率显著低于高恶病质指数组（5 年生存率：86.3% vs. 63.1%，p<0.01；87.9% vs. 67.2%，p<0.01）。多因素分析显示，T3 或 T4（危险比[HR]：2.56；95%置信区间[CI] 1.04-6.25，p=0.039）、III 期（HR：3.77；95% CI 1.79-7.93，p<0.01）和低恶病质指数（HR：2.27；95% CI 1.31-3.90，p=0.003）是无病生存的显著独立预测因素。CA19-9≥37.0ng/mL（HR：2.68；95% CI：1.37-5.24，p=0.004）、III 期（HR：2.57；95% CI 1.34-4.92，p=0.004）和低恶病质指数（HR：2.35；95% CI 1.31-4.21，p=0.004）是总生存的显著独立预测因素。
低恶病质指数可能是结直肠癌的长期预后因素。
