Prognostic significance of the cachexia index in patients with stage I-III colorectal cancer who underwent laparoscopic surgery.

ABSTRACT

PURPOSE: The prognostic significance of the cachexia index, a novel biomarker of cancer cachexia, remains unclear in colorectal cancer; we, therefore, evaluated this relationship. METHODS: 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 [cm2/m2] × serum albumin level [g/dL])/neutrophil-to-lymphocyte ratio. The overall and disease-free survival rates were analyzed using a Cox proportional hazards model. RESULTS: 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. CONCLUSION: A low cachexia index might be a long-term prognostic factor of colorectal cancer.