Novel prognostic factor in the colorectal cancer patients who underwent laparoscopic surgery

Toshihiro Nakao, Mitsuo Shimada, Kozo Yoshikawa, Jun Higashijima, Takuya Tokunaga, Masaaki Nishi, Chie Takasu, Hideya Kashihara. Department of Surgery, The University of Tokushima

Background: Recently, much attention has been paid to the sarcopenia, Glasgow prognostic score (GPS) and neutrophil-to-lymphocyte ratio (NLR) to predict the prognosis of several cancers. The aim of the present study was to assess the efficacy of sarcopenia, GPS and NLR as the prognostic factors in the colorectal cancer patient who underwent laparoscopic surgery and establish the new prognosis score.

Patients and methods: Seventy-six colorectal cancer patients who underwent radical laparoscopic surgery between January 2004 and April 2009 were analyzed. Cross-sectional areas (cm2) of skeletal muscle were measured at the third lumbar vertebra by computed tomography. The presence of sarcopenia was defined as skeletal muscle area under 75% of the standard area of skeletal muscle at the third lumbar vertebra. Preoperative NLR was calculated. The cut-off value of NLR was defined as 3.2 by median value. The GPS was calculated based on cut-off values of 1.0 mg/dl for CRP and 3.5 g/dl for Alb, as previously reported. The new predictive score, sarcoGPS, was calculated based on CRP and the presence of sarcorenia instead of Alb. The cancer-specific survival (CSS), disease-free survival (DFS), postoperative complication rate and postoperative hospital stay were evaluated.

Results: There was no significant difference of CSS in GPS, NLR (p=0.48, 0.27). The CSS in sarcopenia patients was significant worse than non-sarcopenia patients (p>0.05).  The CSS in patients with sarcoGPS 2 tended to be worse than sarcoGPS 0 and 1 (p=0.07). There was no significant difference of DFS, postoperative complication rate and postoperative hospital stay in sarcopenia, NLR, GPS and sarcoGPS.

Conclusion: The sarcopenia and sarcoGPS may be the prognostic factors in the colorectal cancer patients who underwent laparoscopic surgery.

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