Diagnostic utility of the preoperative cachexia index for malnutrition in colorectal cancer: A prospective cohort study.

BACKGROUND

Cachexia is a multifactorial syndrome characterized by weight and muscle loss, often linked to malnutrition and inflammation. Malnutrition affects almost 40 % of colorectal cancer (CRC) patients, contributing to worse surgical outcomes, higher morbidity, and increased mortality. This study evaluates the Cachexia Index (CXI) for malnutrition detection in CRC patients.

PATIENTS AND

METHODS

Seventy patients (54.3 % men; median age 65) underwent bioelectrical impedance analysis, blood tests, and nutritional assessments before surgery. Patients were recruited between November 1, 2023, and October 30, 2024. CXI, calculated as [Skeletal Mass Index × Serum Albumin]/Neutrophil-to-Lymphocyte-Ratio, was compared with the Subjective Global Assessment.

RESULTS

The median CXI was 13.7 (range: 1.9-53.8), with malnourished or at-risk patients exhibiting significantly lower median CXI values (9.5 vs. 14.9; p = 0.0262) than well-nourished individuals. Tumor location also influenced CXI; patients with sigmoid colon tumors had the highest median CXI, while those with caecum tumors had the lowest (22.2 vs. 8.2; p = 0.0202). CXI demonstrated 100 % sensitivity and 60 % specificity for malnutrition detection, with a cutoff of ≤12.09 (AUC = 0.80; 95 % CI: 0.69-0.89; p < 0.0001). Malnourished patients had a significantly lower median CXI (9.5 vs. 14.9; p = 0.0262).

CONCLUSIONS

These findings support CXI as a reliable, non-invasive biomarker for malnutrition in CRC patients, with potential applications in personalized nutritional and therapeutic care.