Inflammatory Markers Have Prognostic Value in Patients With CRC

Prognostic values for colorectal cancer (CRC) were found in inflammatory markers of C-reactive protein (CRP), lymphocyte to CRP ratio (LCR), and CRP to albumin ratio (CAR), according to a study published in Journal of Cachexia, Sarcopenia, and Muscle. Survival predictions could be made by evaluating these inflammation parameters.

CRC is third in the world in morbidity and mortality in men and women. Up to 60% of patients with CRC develop cachexia. The condition is associated with loss of weight, skeletal muscle, and muscle strength, which can result in decreased tolerance to chemotherapy. CRP is a systemic inflammation indicator; systemic inflammation has been found to be linked to quality of life. This study aimed to assess the prediction value of systemic inflammation and Eastern Cooperative Oncology Group Performance Status (ECOG PS) in differentiating patients with CRC who are noncachectic or cachectic.

Doctor projects the human large intestine on the tablet | Image credit: Tom - stock.adobe.com

Studies with data from 2013 to 2021 were analyzed for their connection between nutritional status and clinical outcomes of malignant tumors. Patients were eligible if they were 18 years and older, had a hospital stay of more than 48 hours, had a cancer diagnosis, and could fill out a questionnaire. The questionnaires, body measurements, and a blood sample were collected within the first 48 hours of hospitalization. Demographic data was collected from all patients, and comprised age, sex, body mass index, smoking status, and comorbidities.

There were 905 patients with CRC included in this study, with a mean (SD) age of 59.30 (11.50) years, and there were 528 male patients. A total of 344 patients had CRC cachexia; these patients were more likely to be younger, have advanced tumors, have a higher ECOG PS score, and have lower albumin levels, lymphocyte levels, CRP levels, and CAR levels.

LCR, CAR, and CRP were found to have better prognostic predictive ability compared with lymphocyte CRP score (LCS), modified nutritional geriatric risk index (mGNRI), and modified Glasgow prognostic score (mGPS) in the patients who had CRC. A C-index analysis also found that LCR, CAR, and CRP had good prognostic value in patients with CRC (C-index LCR, 0.711; 95% CI, 0.679-0.742; C-index CAR, 0.709; 95% CI, 0.677-0.741; C-index CRP, 0.703; 95% CI, 0.671-0.736). Patients with CRC cachexia had good prognostic values as well in the same parameters (C-index LCR, 0.745; 95% CI, 0.702-0.787; C-index CAR, 0.754; 95% CI, 0.712-0.798; C-index CRP, 0.745; 95% CI, 0.701-0.789) compared with mGNRI, LCS, and mGPS.

Poor survival outcomes were found in patients with low LCR, high CAR, or high CRP levels. Patients with CRC with and without cachexia and patients with low LCR, high CAR, and high CRP had worse prognosis.

There were some limitations to this study. This was a cross-sectional analysis, so further longitudinal and interventional studies will be required to establish the relationship. Also, other observations were not collected from patients with CRC, such as deaths related and not related to cancer, and the final consensus could be advanced from identifying uniform threshold values for inflammatory biomarkers.

The researchers concluded that LCR, CAR, and CRP as systemic inflammatory markers are useful as stable prognostic values in patients with CRC. A prognostic prediction framework could be provided using this evaluation of systemic inflammation.

Reference

Ruan GT, Xie HL, Yuan KT, et al. Prognostic value of systemic inflammation and for patients with colorectal cancer cachexia. J Cachexia Sarcopenia Muscle. Published online October 30, 2023. doi:10.1002/jcsm.13358