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BACKGROUND & AIMS: The association of Prognostic Nutritional Index (PNI) with prognosis has been established for various cancer types, including rectal cancer. However, the precise relationship between PNI and body composition characteristics in patients with non-metastatic rectal cancer remain unclear. This study aimed to investigate the impact of PNI on overall survival and disease-free survival in non-metastatic rectal cancer patients undergoing total surgical resection. Additionally, it sought to assess the inflammatory status and body composition in patients across different PNI levels. METHODS: Patients with non-metastatic rectal cancer who underwent total surgical resection, were consecutively enrolled. PNI was calculated using the formula: PNI = (10 × serum albumin [g/dl]) + (0.005 × lymphocytes/µL). Body composition was assessed using CT-derived measurements and laboratory tests performed at diagnosis were used to calculate inflammatory indices. Univariate and multivariate logistic regression analyses as well as Kaplan-Meier curves were used to determine prognostic values. RESULTS: A total of 298 patients were included. Patients with low PNI demonstrated significantly reduced overall survival and disease-free survival compared to those with high PNI (Hazard ratio [HR] 1.85; Confidence interval [CI] 1.30-2 0.62; p = 0.001). Moreover, patients with low PNI exhibited heightened systemic inflammatory status and reduced skeletal muscle index, increased muscle radiodensity, as well as a decrease in subcutaneous adipose tissue area, subcutaneous fat index, and low attenuation of both subcutaneous and visceral adipose tissue. CONCLUSION: The PNI, assessed prior to treatment initiation, serves as a prognostic biomarker for non-metastatic rectal cancer patients undergoing total surgical resection and is linked with both inflammation and alterations in body composition.
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BACKGROUND/OBJECTIVES: The association between systemic inflammation and myosteatosis upon diagnosis of gastric cancer (GC) and whether these factors could predict survival outcomes is not clear. Our aim was to explore the association between systemic inflammation and myosteatosis upon diagnosis of GC, specially whether the co-occurrence of these factors could predict survival outcomes. SUBJECTS/METHODS: Computed tomography (CT) was performed at the level of the third lumbar vertebra for body composition analysis in 280 patients with GC. Myoesteatosis was defined as the lowest tertile of the muscle radiodensity distribution or based on clinical significance using optimal stratification analysis. Inflammatory indexes were measured, including the neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte and lymphocyte-to-monocyte ratios. RESULTS: Patients with low skeletal muscle (SM) radiodensity were more likely to be older than 65 years, have a higher body mass index and have diabetes. They also had higher intermuscular visceral and subcutaneous adipose tissue areas and indexes. The highest tertile of SM radiodensity was associated with better disease-free survival (DFS) (HR = 0.51, 95% CI [0.31, 0.84], ptrend = 0.020) and overall survival (OS) (HR = 0.49, 95% CI [0.29, 0.82], ptrend = 0.022). Patients with NLR > 2.3 and myosteatosis had the worst DFS and OS (HR = 2.77, 95% CI [1.54, 5.00], p = 0.001; HR = 3.31, 95% CI [1.79, 6.15], p < 0.001, respectively). CONCLUSION: Co-occurrence of myosteatosis and inflammation increased disease progression and death risk by almost three times. These regularly obtained biomarkers might improve prognostic risk prediction in resectable GC.
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Neoplasias Gástricas , Humanos , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/complicações , Músculo Esquelético/diagnóstico por imagem , InflamaçãoRESUMO
OBJECTIVES: Adipose tissue distribution and radiodensity are associated with prognosis in many types of cancer. However, the roles of adipose tissue distribution and radiodensity in patients with metastatic colorectal cancer (mCRC) remain unclear. The aim of this study was to assess the prognostic effect of adiposity and adipose tissue radiodensities in patients with mCRC. METHODS: Patients with mCRC who received first-line palliative chemotherapy and had a computed tomography (CT) scan at the third lumbar vertebra (L3) level, admitted between January 2010 and December 2018, were sequentially enrolled. Body composition was assessed using CT-derived measurements. Univariate and multivariate logistic regression analyses and Kaplan-Meier curves were used to determine prognostic values. RESULTS: The study included 237 patients. Cox analyses demonstrated that high subcutaneous adipose tissue (SAT) index was associated with a lower risk for death (hazard ratio [HR], 0.51; 95% confidence interval [CI], 0.29-0.88; Ptrend < 0.025). There was no significant association between visceral adipose tissue (VAT) index tertiles and overall survival. However, high VAT and SAT radiodensities were significantly associated with increased mortality (HR, 1.80; 95% CI, 1.12-2.89; Ptrend < 0.030 and HR, 1.85; 95% CI, 1.19-2.86; Ptrend < 0.021, respectively). CONCLUSIONS: A higher SAT index in patients with mCRC was associated with a favorable overall survival outcome, whereas higher SAT and VAT radiodensities were associated with an increased risk for death, supporting that early nutritional intervention may improve mCRC prognosis.
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Adiposidade , Neoplasias do Colo , Humanos , Prognóstico , Obesidade , Gordura Subcutânea/diagnóstico por imagem , Obesidade Abdominal/complicações , Obesidade Abdominal/diagnóstico por imagem , Biomarcadores , Gordura Intra-Abdominal/diagnóstico por imagemRESUMO
In epidemiological studies, higher calcium intake has been associated with decreased colorectal cancer (CRC) incidence. However, whether circulating calcium concentrations are associated with CRC prognosis is largely unknown. In this retrospective cohort analysis, we identified 498 patients diagnosed with stage I-IV CRC between the years of 2000 and 2018 in whom calcium and albumin level measurements within 3 months of diagnosis had been taken. We used the Kaplan-Meier method for survival analysis. We used multivariate Cox proportional hazards regression to identify associations between corrected calcium levels and CRC survival outcomes. Corrected calcium levels in the highest tertile were associated with significantly lower progression-free survival rates (hazard ratio (HR) 1.85; 95% confidence interval (CI) 1.28-2.69; p = 0.001) and overall survival (HR 1.86; 95% CI 1.26-2.74, p = 0.002) in patients with stage IV or recurrent CRC, and significantly lower disease-free survival rates (HR 1.44; 95% confidence interval (CI) 1.02-2.03; p = 0.040) and overall survival rates (HR 1.72; 95% CI 1.18-2.50; p = 0.004) in patients with stage I-III disease. In conclusion, higher corrected calcium levels after the diagnosis of CRC were significantly associated with decreased survival rates. Prospective trials are necessary to confirm this association.
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Body composition performed by computed tomography (CT) impacts on cancer patients' prognoses and responses to treatment. Myosteatosis has been related to overall survival (OS) and disease-specific survival in colorectal cancer (CRC); however, the independent impact of the association of myosteatosis with prognosis in colon cancer (CC) and rectal cancer (RC) is still unclear. CT was performed at the L3 level to assess body composition features in 227 patients with CRC. Clinical parameters were collected. Overall survival (OS) was the primary outcome, and the secondary outcome was disease-free survival (DFS). Skeletal muscle attenuation and intramuscular adipose tissue area were associated with DFS (p = 0.003 and p = 0.011, respectively) and OS (p < 0.001 and p < 0.001, respectively) in CC patients but not in RC patients. Only the skeletal muscle area was associated with better prognosis related to OS in RC patients (p = 0.009). When CC and RC were analyzed separately, myosteatosis influenced survival negatively in CC patients, worsening DFS survival (hazard ratio [HR], 2.70; 95% confidence interval [CI], 1.07-6.82; p = 0.035) and OS (HR, 5.76; 95% CI, 1.31-25.40; p = 0.021). By contrast, the presence of myosteatosis did not influence DFS (HR, 1.02; 95% CI, 0.52-2.03; p = 0.944) or OS (HR, 0.76; 95% CI, 0.33-1.77; p = 0.529) in RC patients. Our study revealed the interference of myosteatosis in the therapy and survival of patients with CC but not in those with RC, strengthening the value of grouping the two types of cancer in body composition analyses.
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Hyaluronic Acid-binding protein 4 (HABP4) is a regulatory protein of 57 kDa that is functionally involved in transcription regulation and RNA metabolism and shows several characteristics common to oncoproteins or tumor suppressors, including altered expression in cancer tissues, nucleus/cytoplasm shuttling, intrinsic lack of protein structure, complex interactomes and post translational modifications. Its gene has been found in a region on chromosome 9q22.3-31, which contains SNP haplotypes occurring in individuals with a high risk for familial colon cancer. To test a possible role of HABP4 in tumorigenesis we generated knockout mice by the CRISPR/Cas9 method and treated the animals with azoxymethane (AOM)/dextran sodium sulfate (DSS) for induction of colon tumors. HABP4-/- mice, compared to wild type mice, had more and larger tumors, and expressed more of the proliferation marker proteins Cyclin-D1, CDK4 and PCNA. Furthermore, the cells of the bottom of the colon crypts in the HABP4-/- mice divided more rapidly. Next, we generated also HABP4-/- HCT 116 cells, in cell culture and found again an increased proliferation in clonogenic assays in comparison to wild-type cells. Our study of the protein expression levels of HABP4 in human colon cancer samples, through immunohistochemistry assays, showed, that 30% of the tumors analyzed had low expression of HABP4. Our data suggest that HABP4 is involved in proliferation regulation of colon cells in vitro and in vivo and that it is a promising new candidate for a tumor suppressor protein that can be explored both in the diagnosis and possibly therapy of colon cancer.
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Increased adiposity and its attendant metabolic features as well as systemic inflammation have been associated with prognosis in locally advanced esophageal cancer (LAEC). However, whether myosteatosis and its combination with systemic inflammatory markers are associated with prognosis of esophageal cancer is unknown. Our study aimed to investigate the influence of myosteatosis and its association with systemic inflammation on progression-free survival (PFS) and overall survival (OS) in LAEC patients treated with definitive chemoradiotherapy (dCRT). We retrospectively gathered information on 123 patients with LAEC submitted to dCRT at the University of Campinas Hospital. Computed tomography (CT) images at the level of L3 were analyzed to assess muscularity and adiposity. Systemic inflammation was mainly measured by calculating the neutrophil-to-lymphocyte ratio (NLR). Median PFS for patients with myosteatosis (n = 72) was 11.0 months vs 4.0 months for patients without myosteatosis (n = 51) (hazard ratio [HR]: 0.53; 95% confidence interval [CI], 0.34-0.83; P = .005). Myosteatosis was also independently associated with a favorable OS. Systemic inflammation (NLR > 2.8) was associated with a worse prognosis. The combination of myosteatosis with systemic inflammation revealed that the subgroup of patients with myosteatosis and without inflammation presented less than half the risk of disease progression (HR: 0.47; 95% CI: 0.26-0.85; P = .013) and death (HR: 0.39; 95% CI, 0.21-0.72; P = .003) compared with patients with inflammation. This study demonstrated that myosteatosis without systemic inflammation was independently associated with favorable PFS and OS in LAEC patients treated with dCRT.
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Adenocarcinoma/mortalidade , Carcinoma de Células Escamosas/mortalidade , Neoplasias Esofágicas/mortalidade , Sarcopenia/mortalidade , Adenocarcinoma/diagnóstico por imagem , Tecido Adiposo , Idoso , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Índice de Massa Corporal , Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias Esofágicas/diagnóstico por imagem , Feminino , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Músculo Esquelético , Prognóstico , Sarcopenia/diagnóstico por imagem , Análise de Sobrevida , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND & AIMS: Sarcopenia has been associated with poor prognosis in a number of malignancies. However, whether sarcopenia is associated with colorectal cancer (CRC) prognosis in a metastatic setting remains unclear. The aim of the study presented was to evaluate the impact of sarcopenia on progression-free survival (PFS) and overall survival (OS) in patients with metastatic CRC. METHODS: We retrospectively studied 72 patients with stage IV CRC treated at the University of Campinas between 2009 and 2015. Computed tomography images were analyzed to assess body composition. The Kaplan-Meier and multivariate Cox proportional hazards regression were used for survival analysis and to evaluate the influence of sarcopenia on PFS and OS. RESULTS: Median PFS for sarcopenic patients (n = 32) was 7.2 months, which was significantly different from non-sarcopenic patients (n = 40), which was 15.2 months (hazard ratio [HR]: 1.78; 95% confidence interval [CI], 1.00-3.14; P = 0.048). Sarcopenia was also a significant predictor of OS. Median OS for sarcopenic patients was 12.5 months versus 36.7 months for non-sarcopenic patients (HR: 1.86; 95% CI, 1.02-3.38; P = 0.043), after adjustment for number of metastatic lesions, metastasectomy, and performance status. CONCLUSIONS: Sarcopenia was associated with worse CRC PFS and OS. These findings require prospective trials to validate this association.
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Neoplasias Colorretais/mortalidade , Sarcopenia/complicações , Brasil , Neoplasias Colorretais/complicações , Neoplasias Colorretais/patologia , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Prognóstico , Estudos RetrospectivosRESUMO
OBJECTIVE: To analyze the sociodemographic, dietary and nutritional profile of women with breast cancer. Data Source: A case-control study was conducted in a public hospital in Minas Gerais state involving 43 women with breast cancer and a control group of 78 women. Sociodemographic, anthropometric and dietary analyses were carried out. Diet quality was measured by the Healthy Eating Index adapted for the Brazilian population. Data between groups were compared using the Chi-square and Fisher tests. Student Ìs ttest and Mann-Whitney U test were used to compare the diet quality between the women with breast cancer and those of the control group. DATA SYNTHESIS: Most of the women with breast cancer had low educational level, lower socioeconomic status, higher frequency of overweight, and diet quality classified as needing improvement. In relation to food intake, the women with breast cancer consumed a higher amount of dairy products compared with those of the control group. CONCLUSIONS: The women with breast cancer were classified as of lower socioeconomic level, overweight, and with diet requiring improvements. Studies on breast cancer should investigate such characteristics because this is a disease of multifactorial origin which presents several risk factors
OBJETIVO: Caracterizar o perfil sociodemográfico, nutricional e dietético de mulheres com câncer de mama. MÉTODOS: Trata-se de um estudo caso-controle realizado em hospital público de Minas Gerais com 43 mulheres com câncer de mama e 78 mulheres do grupo controle. Foram realizadas as análises sociodemográficas, antropométricas e dietéticas. A qualidade da dieta foi medida pelo Índice de Alimentação Saudável adaptado para a população brasileira. Realizaram-se os testes Qui-quadrado e Exato de Fisher para comparar as variáveis entre os grupos e os testes t-Student e U-Mann-Whitney na comparação da qualidade da dieta entre o grupo de mulheres com câncer de mama e grupo controle. Resultados: A maior parte das mulheres com câncer de mama apresentou baixa escolaridade, pior condição socioeconômica, maior frequência de excesso de peso e qualidade da dieta classificada como necessitando de melhorias. Em relação ao consumo alimentar, esse grupo apresentou maior consumo de produtos lácteos quando comparado ao grupo controle. CONCLUSÕES: Mulheres com câncer de mama foram classificadas com pior nível socioeconômico, excesso de peso e dieta pontualmente inadequada. Estudos sobre neoplasia mamária devem investigar tais características, já que essa é uma doença de origem multifatorial e, portanto, apresenta vários fatores de risco
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Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias da Mama , Perfil de Saúde , Hospitais Públicos/estatística & dados numéricos , Avaliação NutricionalRESUMO
A case-control study was conducted to assess the levels of α-tocopherol, retinol, and ß-carotene in different tissues and the genetic expression of inflammatory mediators in women with breast cancer. The study included 51 women divided into two groups: case (n = 25) and benign breast disease (n = 26). We evaluated the dietary intake of α-tocopherol, retinol, and ß-carotene and measured plasma and tissue concentrations of these compounds and the inflammatory mediators IL-8, IL-10, and IFNγ. The benign breast disease group showed greater ingestion of α-tocopherol (P = 0.04) and ß-carotene (P = 0.011). The concentration of tissue α-tocopherol was reduced in the case group (P = 0.005). The expression of IL-10, IL-8, and IFNγ increased by 231.0, 49.1, and 57.5%, respectively in the case group. The results show that antioxidant nutrients possibly exert biological effects in preventing breast cancer and the immune response is activated in the course of the disease, given the increased expression of proinflammatory and anti-inflammatory compounds with the aid of food.