RESUMO
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.
RESUMO
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.
