Not all colon cancer patients with preoperative hyperinflammatory status are at high risk of muscle loss and poor prognosis

Abstract

Purpose: Growing evidence indicates that preoperative hyperinflammation is an independent risk factor for postoperative sarcopenia and poor prognosis in patients with colon cancer. However, inflammation fluctuates with tumor burden and immune status after surgery, and its role in muscle degradation remains unclear. This study aimed to explore the impact of different inflammatory trajectories on muscle wasting. Methods: This retrospective study included 193 patients who are diagnosed with stage II or III colon cancer between 2015 and 2021. The preoperative and postoperative neutrophil-to-lymphocyte ratio (NLR) and prognostic immunological and nutritional index (PINI) were used to assess inflammation, and the subjects divided into four groups: a group with consistently low inflammation (G1), a group with initially high but postoperative decreased inflammation (G2), a group with initially low but postoperative increased inflammation (G3), and a group with consistently high inflammation (G4). Logistic regression identified risk factors for postoperative sarcopenia, while multivariate linear regression assessed the impact of inflammation on skeletal muscle index (SMI%) and density loss rate (SMD%). Cox models calculated overall survival (OS) and recurrence-free survival (RFS). Results: For all the assessed markers, the SMI% and SMD% in G4 significantly increased compared to G1 (P < 0.05), while G2 and G3 showed no significant change at 12 months (P > 0.05). Elevated inflammation was an independent risk factor for postoperative sarcopenia (P < 0.05). Postoperative sarcopenia and PINI in G4 independently influenced OS and RFS. Conclusions: Only patients with persistent postoperative inflammation, not all patients with preoperative inflammation, are at increased risk for muscle wasting and poor prognosis. These findings suggest that modulating postoperative inflammation could reduce muscle loss and improve survival; these findings guide the future development of anti-inflammatory therapies for suitable populations.