Abstract 513P
Background
Proper patient selection for palliative systemic treatment is crucial in older adults with metastatic gastrointestinal cancers (mGIC). Information on CT-based body composition, physical function, and systemic inflammation obtained at the time of diagnosis has the potential to support prognostic understanding and shared decision-making ensuring tailored care in a population where frailty is common.
Methods
We investigated the prognostic value of CT-based body composition (abdominal muscle compartment (AMC) and adipose tissue, intramuscular (IMAT), visceral (VAT), and subcutaneous (SAT)), functional status (ECOG PS), and systemic inflammation (neutrophil/lymphocyte ratio (NLR), Glasgow Prognostic Score (GPS), and CRP) regarding overall survival (OS) in older adults with mGIC. We included patients in this analysis from two prospective cohorts enrolling adults ≥70 years with mGIC between 2015-2018. CT-scans, ECOG PS, and blood samples were collected at baseline. Descriptive statistics, survival analysis, and Cox regression were applied; moreover, C-statistics were estimated.
Results
337 patients (206 men) were eligible with a median age of 76 years (IQR: 72-79); 70% had colorectal cancer. While body composition parameters were significantly associated with body-mass index, CRP, GPS, and NLR were correlated with ECOG PS, weight loss, and se-LDH. In multivariable analyses for OS, patients with higher AMC had lower risk for death (HR=0.67, 95% CI: 0.48-0.92, p=0.013); patients presented with impaired functional status (ECOG PS 1-2) or systemic inflammation (CRP>10, GPS>0) had significant higher risk for shorter OS (Table). Table: 513P
Overall survival according to physical function, systemic inflammation, and body composition parameters: Multivariable analyses
| Marker | n | Overall survival | |||
| Hazard ratio | 95% CI | p-value | AUC | ||
| Body composition (cm2) | |||||
| AMC | |||||
| <123.4 | 149 | 1.00 | 0.013 | 0.65 | |
| ≥123.4 | 180 | 0.67 | 0.48-0.92 | ||
| IMAT | |||||
| <11.88 | 149 | 1.00 | 0.075 | 0.61 | |
| ≥11.88 | 180 | 1.26 | 0.98-1.61 | ||
| VAT | |||||
| <119.3 | 147 | 1.00 | 0.182 | 0.61 | |
| ≥119.3 | 182 | 0.83 | 0.63-1.09 | ||
| SAT | |||||
| <155.1 | 145 | 1.00 | 0.364 | 0.60 | |
| ≥155.1 | 184 | 0.88 | 0.68-1.15 | ||
| Physical function | |||||
| ECOG PS | |||||
| 0 | 84 | 1.00 | NA | 0.70 | |
| 1 | 131 | 1.48 | 1.11-1.98 | 0.008 | |
| ≥2 | 73 | 2.85 | 1.99-4.10 | <0.001 | |
| Systemic inflammation | |||||
| CRP (mg/L) | |||||
| ≤ 10 | 171 | 1.00 | 0.001 | 0.70 | |
| > 10 | 155 | 1.56 | 1.19-2.03 | ||
| NLR | |||||
| ≤ 2.2 | 179 | 1.00 | 0.167 | 0.69 | |
| > 2.2 | 150 | 1.20 | 0.93-1.55 | ||
| GPS | |||||
| 0 | 168 | 1.00 | 0.004 | 0.61 | |
| 1-2 | 161 | 1.42 | 1.11-1.82 |
Conclusions
Increased muscle mass reduced the risk of early death in older adults with mGIC. ECOG PS and CRP are accessible in clinical practice; this important prognostic information should be included in shared decision-making.
Clinical trial identification
Danish Data Protection Agency: J. nr.16/8147; Danish Regional Ethical Comitte: J. nr. S-20162000-48; EudraCT 2014-000394-39.
Legal entity responsible for the study
Gabor Liposits.
Funding
Academy of Geriatric Cancer Research (AgeCare) and Dansih Cancer Society.
Disclosure
G. Liposits: Financial Interests, Personal, Other, Received funding for working in an expert panel.: Nutricia AS; Financial Interests, Personal, Invited Speaker, Workshop: Servier; Non-Financial Interests, Member: International Society of Geriatric Oncology (SIOG). All other authors have declared no conflicts of interest.