Systemic inflammation and sarcopenia have high potential as biomarkers for clinical use in prognostication and in guiding intervention, according to research published in JAMA Oncology (online December 14, 2017; doi:10.1001/jamaoncol.2017.2319).
Not only are systemic inflammation and sarcopenia easily evaluable, but they also predict mortality in many types of cancer and are potentially modifiable. Symptoms of inflammation and sarcopenia simultaneously may help identify patients with early-stage colorectal cancer with poor prognosis, but further research is necessary to validate this hypothesis.
Elizabeth M Cespedes Feliciano, ScD, MSc, Kaiser Permanente Northern California, and colleagues investigated potential associations of pre-diagnostic systemic inflammation with at-diagnosis sarcopenia, as well as whether these factors interact to predict colorectal cancer survival. A prospective cohort of 2470 patients with stage I-III disease from 2006 through 2011 was formed.
The main outcome of the study was all-cause or disease-specific mortality. Researchers used computed tomography scans to calculate skeletal muscle index. Additionally, researchers adjusted for age, ethnicity, sex, body mass index, stage, and cancer site in their analysis.
After a median follow-up of 6 years, researchers reported 656 deaths, 357 of which were from colorectal cancer. Increasing neutrophil to lymphocyte ratio (NLR) was associated with sarcopenia in a dose-response manner (compared with NLR < 3, OR, 1.35; 95% CI, 1.10-1.67; NLR 3 to < 5; 1.47; 95% CI, 1.16-1.85; NLR ≥ 5; P < .001). An NLR of at least 3 and sarcopenia independently predicted all-cause and disease-specific mortality.
Additionally, researchers acknowledged that patients with both sarcopenia and NLR of at least 3 had twice the risk of all-cause and disease-specific death, compared with patients that had neither sarcopenia nor NLR of at least 3.
In their concluding remarks, researchers wrote that not only is pre-diagnosis inflammation associated with at-diagnosis sarcopenia, but also sarcopenia combined with inflammation doubles the risk of death. This finding, they wrote, could enhance prognostication, and “a better understanding of how the host inflammatory/immune response influences changes in skeletal muscle may open new therapeutic avenues to improve cancer outcomes.”—Zachary Bessette