Body Composition, Inflammation, and 5-Year Outcomes in Colon Cancer
Authors: Christina A. Fleming, Emer P. O’Connell, Richard G. Kavanagh, Donal P. O’Leary, Maria Twomey, Mark A. Corrigan, Jiang H. Wang, Michael M. Maher, Owen J. O’Connor, Henry P. Redmond
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Obesity, particularly visceral obesity and sarcopenia, are poor prognostic indicators in colon cancer. <h3>Objectives</h3> To explore the association between body composition profiles and 5-year colon cancer outcomes and delineate the associated underlying inflammatory processes. <h3>Design, Setting, and Participants</h3> This multicenter translational cohort study included patients with nonmetastatic colon cancer who did not have underlying chronic inflammatory disorders and were not receiving anti-inflammatory drugs referred to tertiary cancer centers from 2009 to 2015. Preoperative acute phase proteins (white cell count, C-reactive protein, and albumin), cytokines (interleukin [IL]-1b, IL-2, IL-6, IL-10, interferon γ, and tumor necrosis factor α), vascular endothelial growth factor (VEGF), and cell surface receptor expression levels (CD11b and CD14) were measured. All patients underwent follow-up for at least 5 years. Data were analyzed in December 2020. <h3>Exposure</h3> Nonmetastatic colon cancer. <h3>Main Outcomes and Measures</h3> The associations of body composition profiles with 5-year cancer recurrence and disease-specific mortality were analyzed using Mantel Cox log-rank test and Kaplan-Meier curves. <h3>Results</h3> A total of 28 patients were included (median [interquartile range] age, 67 [58-72] years; 22 [78.6%] men). Low skeletal muscle area (SMA) and high visceral to total fat ratio were associated with poor clinical and oncological outcomes, including increased 5-year recurrence (low SMA: hazard ratio [HR], 2.30 [95% CI, 1.41-2.89];<i>P</i> = .04; high visceral to total fat ratio: HR, 5.78 [95% CI, 3.66-7.95];<i>P</i> = .02). High visceral to total fat ratio was associated with increased 5-year disease-specific mortality (HR, 5.92 [95% CI, 4.04-8.00];<i>P</i> = .02). Patients with low SMA who developed a cancer recurrence, compared with those who did not, had higher C-reactive protein (mean [SD], 31.24 [6.95] mg/dL vs 8.11 [0.58] mg/dL;<i>P</i> = .003), IL-6 (mean [SD], 1.93 [1.16] ng/mL vs 0.88 [0.14] ng/mL;<i>P</i> = .004), VEGF (mean [SD], 310.03 [122.66] ng/mL vs 176.12 [22.94] ng/mL;<i>P</i> = .007), and CD14 (mean [SD], 521.23 [302.02] ng/mL vs 322.07 [98.35] ng/mL;<i>P</i> = .03) expression and lower albumin (mean [SD], 3.8 [0.6] g/dL vs 43.50 [3.69] g/dL;<i>P</i> = .01), IL-2 (mean [SD], 0.45 [0.25] ng/mL vs 0.94 [0.43] ng/mL;<i>P</i> &lt; .001), IL-10 (mean [SD], 8.15 [1.09] ng/mL vs 16.32 [4.43] ng/mL;<i>P</i> = .004), and interferon γ (mean [SD], 2.61 [1.36] ng/mL vs 14.87 [3.43] ng/mL;<i>P</i> = .02) levels. Patients with high visceral to total fat ratio who developed recurrence had higher levels of IL-6 (mean [SD], 5.26 [7.05] ng/mL vs 2.76 [3.11] ng/mL;<i>P</i> = .03) and tumor necrosis factor α (mean [SD], 5.74 [4.53] ng/mL vs 4.50 [1.99] ng/mL;<i>P</i> = .03). <h3>Conclusions and Relevance</h3> These findings suggest that low SMA and high visceral to total fat ratio were associated with worse colon cancer outcomes and with increased expression of proinflammatory cytokines and VEGF and inhibition of anti-inflammatory cytokines.