Nutritional, Inflammatory, and CT-Derived Body Composition Changes During Adjuvant Chemotherapy for Stage II/III Colorectal Cancer: A Single-Center Retrospective Cohort

Purpose Evidence on how nutritional, inflammatory, and body composition indices change during adjuvant chemotherapy for stage II/III colorectal cancer (CRC) is limited. This study aimed to evaluate these longitudinal changes and identify preoperative predictors of treatment discontinuation and overall survival (OS). Methods This was a retrospective, single-center study of stage II/III CRC patients who were curatively resected and received adjuvant chemotherapy. Nutritional, inflammatory, and body composition indices (including body mass index [BMI], psoas muscle index [PMI], Psoas Muscle Density [PMD], modified Intramuscular Adipose Tissue Content [mIMAC], Geriatric Nutritional Risk Index [GNRI], Prognostic Nutritional Index [PNI], hemoglobin, albumin, lymphocyte, and platelet [HALP] score, neutrophil-to-lymphocyte ratio [NLR], and platelet-to-lymphocyte ratio [PLR]) were obtained preoperatively and 6 months after initiating adjuvant chemotherapy. Subgroup analyses contrasted doublet therapy (CAPOX/FOLFOX) and monotherapy (S-1, UFT/LV, capecitabine). Results Among 142 patients (median age 67 years), several indices (BMI, GNRI, PNI, and HALP score) increased, whereas inflammatory indices (NLR and PLR) decreased from baseline to follow-up. Adjuvant therapy was discontinued in 45 patients (31.7%). Discontinuation predictors differed by regimen: for doublet therapy, poor preoperative nutritional/inflammatory status was significant, whereas for monotherapy, only older age was a predictor. Lower preoperative muscle quality (PMD, mIMAC), but not quantity (PMI), was significantly associated with poorer OS, while other nutritional/inflammatory indices were not. Conclusion Nutritional and inflammatory status was not uniformly worsened after adjuvant chemotherapy, with several indices showing improvement. Muscle quality indices were prognostic for OS, and preoperative nutritional/inflammatory indices helped identify patients at risk for discontinuation, especially for doublet therapy.