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The Relationship Between a New Framework for Cancer Cachexia Based on the Glasgow Prognostic Score (GPS) and CT Body Composition Analysis in Patients With Colorectal Cancer
Euan Douglas*, Colin H. Richards, Campbell S. Roxburgh, Paul G. Horgan, Donald C. Mcmillan
Department of Surgery, University of Glasgow, Glasgow, United Kingdom
Background: Progressive involuntary weight loss in cancer (cancer cachexia) is increasingly recognised as part of syndrome associated with chronic activation of the systemic inflammatory response. Recently it has been proposed that inflammation based prognostic scores (GPS) could form the basis of a clinically useful definition of cancer cachexia (1). The aim of the present study was to examine the relationship between the GPS and CT body composition analysis in patients with primary operable colorectal cancer (CRC).
Patients and Methods: 303 patients with primary operable CRC underwent image analysis of CT scans and total fat index (cm2/m2), subcutaneous fat index(cm2/m2), visceral fat index (cm2/m2) and skeletal muscle index(cm2/m2) were measured. These measurements were related to the GPS groupings of No Cachexia (CRP <10mg/l and albumin >35g/l), Malnourished (CRP <10mg/l and albumin <35g/l), Pre-Cachexia (CRP >10mg/l and albumin >35g/l) and Refractory Cachexia (CRP >10mg/l and albumin <35g/l).
Results: In contrast to the similar clinicopathological characteristics, compared with female patients (n= 136), male patients (n= 167) had an increased visceral fat index (p<0.001) and skeletal muscle index (p<0.001). Whereas, compared with male patients, female patients had an elevated subcutaneous (p<0.001) and total fat index (p=0.001). In both female and male patients with increasing cachexia, according to the above cachexia groupings, there was a progressive reduction in the skeletal muscle index (p <0.001) but not in total fat index, subcutaneous fat index or visceral fat index.
Conclusions: The results of the present study, using CT body composition measurements, appear to confirm the clinical utility of a framework for cancer cachexia based on the GPS.
1. Douglas, E., McMillan, D.C., Towards a simple objective framework for the investigation and treatment of cancer cachexia: The Glasgow Prognostic Score. Cancer Treatment Reviews (2013), doi: http://dx.doi.org/10.1016/j.ctrv.2013.11.007
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