Abstract 3418: Preoperative nutritional status and overall survival among non-metastatic colorectal cancer patients: The ColoCare Study
Authors: Gigic Biljana , Damerell Victoria , Lin Tengda , Ose Jennifer , Kahlert Christoph , Figueiredo Jane C. , Li Christopher I. , Schneider Martin , Shibata David , Siegel Erin M. , Toriola Adetunji T. , Ulrich Cornelia M. 
Published: March 2024

Abstract
Introduction: Preoperative malnutrition in colorectal cancer (CRC) patients undergoing major abdominal surgery is a common and serious issue that affects postoperative recovery and clinical outcomes. The aim of this study was to evaluate the associations between preoperative nutritional status and overall survival (OS) of prospectively followed, non-metastatic CRC patients.
Methods: The target cohort consisted of 415 patients with newly-diagnosed stage I-III CRC who underwent curative surgery at the Heidelberg University Hospital in Germany. Nutritional status was evaluated using predefined accessible laboratory parameters (haemoglobin, albumin, total protein, and thrombocytes), and the Geriatric Nutritional Risk Index (GNRI), a screening tool to identify patients with malnutrition: (GNRI) = 14.89 × serum albumin concentration (g/dl) + 41.7 × present weight/ideal weight. Ideal weight was calculated as follows: height(cm)-100-[(height(cm)-150)/4] for men and height(cm)-100-[(height(cm)-150)/2.5] for women. Patients were categorized into normal vs. out of normal range for laboratory parameters and into four grades of nutrition-related risk: major risk (GNRI: &lt;82), moderate risk (GNRI: 82 to &lt;92), low risk (GNRI: 92 to ≤98), and no risk (GNRI: &gt;98). Vital status has been obtained through study-specific follow-ups or the tumor registry. OS was calculated as the interval between the date of surgery and the date of death from any cause or the last follow-up examination. Using Cox proportional hazards regression, we examined associations of the nutritional status with OS. Models were adjusted for potential confounders.
Results: After a median follow-up of 2.24 years for OS, 13% (54) of the 415 patients died. Of all patients, 35.1%, 3.4%, 12.5%, and 10,8% had values out of the normal range for haemoglobin, albumin, total protein, and thrombocytes, respectively. Further, 6.4%, 33.8%, 29.7%, and 30.2% of the patients had major, moderate, low, and no nutrition-related risk, respectively. Patients with out of normal range haemoglobin and thrombocyte values had a significantly increased risk of death (HRHb: 2.8; 95% CI, 1.6-4.9, p&lt;0.001 and HRThr: 3.0; 95% CI, 1.5-6.1, p=0.003). The major nutrition-related risk group had a significantly increased risk of death compared to the no nutrition-related risk group (HRGNRI: 7.2; 95% CI, 2.7-19.3, p&lt;0.001). We did not observe significant associations between preoperative albumin and total protein values and OS among CRC patients.
Conclusion: Patients with out of normal range levels of preoperative haemoglobin and thrombocytes had a significantly worse OS. Further, the GNRI may have a close relationship with the prognosis in non-metastatic CRC patients. Findings from this study yield important clinical information that could help to strategically combat malnutrition prior to surgery in order to improve clinical outcomes.
Citation Format: Biljana Gigic, Victoria Damerell, Tengda Lin, Jennifer Ose, Christoph Kahlert, Jane C. Figueiredo, Christopher I. Li, Martin Schneider, David Shibata, Erin M. Siegel, Adetunji T. Toriola, Cornelia M. Ulrich. Preoperative nutritional status and overall survival among non-metastatic colorectal cancer patients: The ColoCare Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3418.