Abdominal Aortic Calcification As a Predictor of Incomplete Adjuvant Chemotherapy in Stage III Colorectal Cancer: A Retrospective Cohort Study

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Nov 13

PMID 39534807

Authors

Kouki Imaoka

Manabu Shimomura

Hiroshi Okuda

Takuya Yano

Shintaro Akabane

Masahiro Ohira

Yuki Imaoka

Tetsuya Mochizuki

Minoru Hattori

Hideki Ohdan

Affiliations

Soon will be listed here.

Abstract

Objectives Completion of postoperative adjuvant chemotherapy (AC) contributes to the improved prognosis of patients with pathological stage (pStage) III colorectal cancer (CRC). Therefore, identifying patients with AC intolerance is important. Although abdominal aortic calcification (AAC) indicates frailty, its clinical impact on AC completion remains unclear. This study aimed to clarify the association between AAC and AC incompletion. Methods Patients who underwent AC for pStage III CRC between 2010 and 2021 (n = 161) were enrolled in this study. AAC volume was evaluated by preoperative CT tomography, and the patients were divided into two groups based on an AAC cutoff of 992 mm, determined using the receiver operating characteristic curves for AC completion. We investigated the perioperative clinicopathological factors and compared the frequency and severity of AC adverse events between the groups. Results The high AAC group had a significantly higher proportion of patients with older age, male sex, hypertension, and AC incompletion than the low AAC group. The regimens were not significantly different. No significant difference in the frequency or severity of adverse events was observed in either group. In the multivariate analysis, high AAC and older age were significantly associated with AC incompletion. Furthermore, k-means cluster analysis based on both age and AAC volume also demonstrated an increased risk of AC incompletion in patients with stage III CRC as both age and AAC volume increased. High AAC was associated with diminished improvement in nutritional status or inflammatory markers after the administration of AC. Conclusions High AAC is a potential risk marker for predicting AC incompletion in patients with stage III CRC before introducing AC. This article was previously posted to the Research Square preprint server on May 16, 2024.

References

Morgan E, Arnold M, Gini A, Lorenzoni V, Cabasag C, Laversanne M . Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN. Gut. 2023; 72(2):338-344. DOI: 10.1136/gutjnl-2022-327736. View

Sargent D, Goldberg R, JACOBSON S, Macdonald J, Labianca R, Haller D . A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Engl J Med. 2001; 345(15):1091-7. DOI: 10.1056/NEJMoa010957. View

Ide R, Ohira M, Imaoka Y, Sato K, Kuroda S, Tahara H . Impact of Abdominal Aortic Calcification on Chronic Kidney Disease After Liver Transplantation: A Retrospective Study. Transplant Proc. 2023; 55(4):956-960. DOI: 10.1016/j.transproceed.2023.03.014. View

Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen M, Extermann M . International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol. 2014; 32(24):2595-603. PMC: 4876338. DOI: 10.1200/JCO.2013.54.8347. View

Dobie S, Baldwin L, Dominitz J, Matthews B, Billingsley K, Barlow W . Completion of therapy by Medicare patients with stage III colon cancer. J Natl Cancer Inst. 2006; 98(9):610-9. PMC: 3124351. DOI: 10.1093/jnci/djj159. View

Agatston A, Janowitz W, HILDNER F, Zusmer N, VIAMONTE Jr M, Detrano R . Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990; 15(4):827-32. DOI: 10.1016/0735-1097(90)90282-t. View

Dees E, OReilly S, Goodman S, Sartorius S, Levine M, Jones R . A prospective pharmacologic evaluation of age-related toxicity of adjuvant chemotherapy in women with breast cancer. Cancer Invest. 2000; 18(6):521-9. DOI: 10.3109/07357900009012191. View

Guthrie G, Charles K, Roxburgh C, Horgan P, McMillan D, Clarke S . The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013; 88(1):218-30. DOI: 10.1016/j.critrevonc.2013.03.010. View

von Gruenigen V, Huang H, Beumer J, Lankes H, Tew W, Herzog T . Chemotherapy completion in elderly women with ovarian, primary peritoneal or fallopian tube cancer - An NRG oncology/Gynecologic Oncology Group study. Gynecol Oncol. 2017; 144(3):459-467. PMC: 5570471. DOI: 10.1016/j.ygyno.2016.11.033. View

10.

Yoon Y, Han W, Lee H, Chang M, Huh K, Jung D . Abdominal Aortic Calcification in Living Kidney Donors. Transplant Proc. 2016; 48(3):720-4. DOI: 10.1016/j.transproceed.2016.02.037. View

11.

Weber C, Duchateau-Nguyen G, Solier C, Schell-Steven A, Hermosilla R, Nogoceke E . Cardiovascular risk markers associated with arterial calcification in patients with chronic kidney disease Stages 3 and 4. Clin Kidney J. 2014; 7(2):167-173. PMC: 3968563. DOI: 10.1093/ckj/sfu017. View

12.

Abdel-Rahman O, Tang P, Koski S . Hospitalizations among early-stage colon cancer patients receiving adjuvant chemotherapy: a real-world study. Int J Colorectal Dis. 2021; 36(9):1905-1913. PMC: 8138106. DOI: 10.1007/s00384-021-03952-4. View

13.

Smith C, Sim M, Dalla Via J, Gebre A, Zhu K, Lim W . Extent of Abdominal Aortic Calcification Is Associated With Incident Rapid Weight Loss Over 5 Years: The Perth Longitudinal Study of Ageing Women. Arterioscler Thromb Vasc Biol. 2023; 44(2):e54-e64. PMC: 10832333. DOI: 10.1161/ATVBAHA.123.320118. View

14.

Stenvinkel P, Heimburger O, Lindholm B, Kaysen G, Bergstrom J . Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant. 2000; 15(7):953-60. DOI: 10.1093/ndt/15.7.953. View

15.

Elghiaty A, Kim J, Jang W, Park J, Heo J, Rha K . Preoperative controlling nutritional status (CONUT) score as a novel immune-nutritional predictor of survival in non-metastatic clear cell renal cell carcinoma of ≤ 7 cm on preoperative imaging. J Cancer Res Clin Oncol. 2019; 145(4):957-965. DOI: 10.1007/s00432-019-02846-x. View

16.

Zhang K, Gao J, Chen J, Liu X, Cai Q, Liu P . MICS, an easily ignored contributor to arterial calcification in CKD patients. Am J Physiol Renal Physiol. 2016; 311(4):F663-F670. DOI: 10.1152/ajprenal.00189.2016. View

17.

Yoshino T, Arnold D, Taniguchi H, Pentheroudakis G, Yamazaki K, Xu R . Pan-Asian adapted ESMO consensus guidelines for the management of patients with metastatic colorectal cancer: a JSMO-ESMO initiative endorsed by CSCO, KACO, MOS, SSO and TOS. Ann Oncol. 2017; 29(1):44-70. DOI: 10.1093/annonc/mdx738. View

18.

Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T . Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2019; 25(1):1-42. PMC: 6946738. DOI: 10.1007/s10147-019-01485-z. View

19.

Hackett N, De Oliveira G, Jain U, Kim J . ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg. 2015; 18:184-90. DOI: 10.1016/j.ijsu.2015.04.079. View

20.

Aaldriks A, Maartense E, Nortier H, van der Geest L, le Cessie S, Tanis B . Prognostic factors for the feasibility of chemotherapy and the Geriatric Prognostic Index (GPI) as risk profile for mortality before chemotherapy in the elderly. Acta Oncol. 2015; 55(1):15-23. DOI: 10.3109/0284186X.2015.1068446. View