Abstract
Introduction
Cachexia is a multifactorial syndrome associated with systemic inflammation, nutritional deterioration, and poor prognosis in cancer patients. Colorectal cancer is one of the most prevalent malignancies worldwide, and differences between right- and left-sided tumors may influence clinical outcomes.
Methods
This retrospective observational cohort study included 69 patients who underwent surgical treatment for colorectal cancer at the University Hospital of the University of Sao Paulo between 2012 and 2018. Patients were classified as cachectic (CC; n = 40) or non-cachectic (WSC; n = 29). Clinical, epidemiological, inflammatory, nutritional, and laboratory variables were compared according to cachexia status, primary tumor location, and survival status.
Results
Cachectic patients presented significantly lower BMI, hemoglobin, and albumin levels, as well as higher CRP concentrations, CRP/albumin ratio, GPS, and mGPS values compared with non-cachectic patients. Cachexia was more frequent among patients with right-sided tumors than among those with left-sided tumors, although this difference did not reach statistical significance. Patients who died during follow-up were significantly older than survivors.
Discussion
Cachectic patients with colorectal cancer showed a distinct inflammatory and nutritional profile, supporting the clinical relevance of accessible biomarkers such as CRP, albumin, GPS, and mGPS for patient assessment and risk stratification. Further multicenter studies with larger samples and complete longitudinal follow-up are needed to clarify the prognostic implications of these findings.
Keywords: biomarkers, cachexia, colorectal cancer, inflammation, prognosis
1. Introduction
Cancer-associated cachexia (CAC) is a severe, multifactorial syndrome characterized by involuntary weight loss and muscle wasting. It is one of the primary contributors to cancer morbidity and mortality and is driven by chronic systemic inflammation (1).
Cachexia is a challenging multifactorial and multiorgan clinical entity, associated with unfavorable outcomes in cancer patients and characterized by pronounced involuntary weight loss, systemic inflammation, metabolic disturbances, and anorexia (2).
The consensus diagnostic criterion for cachexia is a weight loss greater than 5% or a weight loss greater than 2% in individuals already presenting with depletion according to current body weight and height [body mass index (BMI) < 20 kg/m2] or skeletal muscle depletion (sarcopenia) (3).
Patients with gastrointestinal cancers, including pancreatic, gastric, and colorectal cancer, are commonly affected by cachexia (4).
Colorectal cancer (CRC) ranks as the third most prevalent neoplasm and the second most common cause of cancer-related deaths worldwide (5).
CRC is a neoplasm affecting the large intestine (colon, rectum, and anus), epidemiologically identified using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), and subdivided into colon (C18), rectosigmoid junction (C19), rectum (C20), and anus (C21) (6, 7).
In Brazil, CRC is the third most common cancer in men and the second most common in women, with an estimated 45,000 new cases during the period 2023–2025 (7).
Several studies have associated primary tumor location (PTL) with prognosis and survival outcomes. Clinical, histological, and molecular differences between right-sided CRC and left-sided CRC (LCC) have gained increasing attention (6).
The right colon originates from the midgut, while the left colon derives from the hindgut. The different microenvironments of the right and left colon can result in distinct mutation profiles during carcinogenesis (8).
There is substantial evidence suggesting that right-sided CRC and left-sided CRC differ in terms of histological and clinical characteristics, including tumor progression and metastatic potential (9).
Numerous articles have investigated the relationship between primary tumor location and CRC prognosis (5).
Right-sided CRC occurs proximal to the splenic flexure and is considered a tumor of the cecum and ascending colon. Histologically, right-sided tumors often present as mucinous adenocarcinomas with a flat morphology and less frequently as sessile serrated adenomas, making distinction from normal colonic tissue difficult. The luminal contents and fluids in the right colon may delay the appearance of symptoms, contributing to diagnostic delay and a worse prognosis due to advanced tumor stage (10).
Left-sided CRC is defined by tumors occurring at or distal to the splenic flexure, including the descending colon, sigmoid colon, and rectum. Its macroscopic morphology is often polypoid and projects into the intestinal lumen. These tumors frequently cause pain and rectal bleeding, allowing easier detection at earlier stages (11).
In Brazil, despite the high incidence of colorectal cancer, organized population-based screening for asymptomatic individuals remains limited within the public healthcare system. Previous Brazilian studies have reported structural and implementation barriers to colorectal cancer screening, which may contribute to delayed diagnosis, advanced disease at presentation, and reduced survival after diagnosis (12–14).
Therefore, this study aimed to compare clinical, epidemiological, inflammatory and laboratory characteristics between patients with right- and left-sided colorectal cancer, considering the presence of cachexia, in order to explore potential associations with clinical outcomes.
2. Methods
2.1. Study design and population
This observational, cross-sectional, retrospective study was approved by the Research Ethics Committee of the University Hospital of the University of São Paulo (HU-USP), São Paulo, Brazil (CEP-HU/USP No. 2079/23; CAAE 70838623.3.3001.0076). The study population comprised patients who underwent surgical treatment for colorectal cancer at HU-USP between 2012 and 2018. Complete clinical, anthropometric, laboratory, and follow-up data were obtained from medical records. A total of 69 patients met the inclusion criteria and were included in the final analysis (Figure 1).
Figure 1.
Flowchart of the study population. Patients undergoing surgical treatment for colorectal cancer at HU-USP between 2012 and 2018 were classified according to cachexia status into cachectic (CC) and non-cachectic (WSC) groups.
2.2. Cachexia classification
Patients were defined according to the international consensus proposed by Fearon et al. (3). Patients were classified as cachectic when presenting involuntary weight loss greater than 5% during the previous six months, or weight loss greater than 2% in individuals with a body mass index (BMI) lower than 20 kg/m2, or in the presence of sarcopenia. According to these criteria, patients were categorized as cachectic (CC; n = 40) or non-cachectic (WSC; n = 29).
2.3. Clinical and laboratory variables
Demographic, clinical, and laboratory variables were extracted from medical records, including age, sex, body mass index (BMI), tumor location, survival status, serum albumin concentration, C-reactive protein (CRP) concentration, Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), and quality-of-life data obtained through the EORTC QLQ-C30 questionnaire. The selected variables were chosen based on their established association with nutritional status, systemic inflammation, prognosis, and survival in patients with colorectal cancer.
2.4. Tumor location and survival assessment
Tumors were classified according to anatomical location as right-sided colon cancer (CD) or left-sided colon cancer (CE). Survival status was assessed using follow-up information available in medical records and categorized as alive or deceased at the end of the observation period.
2.5. Statistical analysis
Continuous variables were expressed as mean and standard deviation (SD), whereas categorical variables were presented as absolute frequencies and percentages. Normality was assessed using the Shapiro–Wilk test before group comparisons. Comparisons between groups were performed using Student's t-test for normally distributed variables and the Mann–Whitney U test for non-normally distributed variables. Categorical variables were compared using Pearson's chi-square test or Fisher's exact test when expected frequencies were lower than five. Statistical significance was defined as p < 0.05. Statistical analyses and graphical visualizations were performed using R statistical software.
2.6. Ethical considerations
All participants provided written informed consent prior to questionnaire administration and data collection. The study was conducted in accordance with the ethical principles established in the Declaration of Helsinki and approved by the Research Ethics Committee of HU-USP.
3. Results
Table 1 summarizes the demographic and laboratory characteristics of the study population. The study included 69 patients, of whom 40 (58.0%) were classified as cachectic (CC) and 29 (42.0%) as non-cachectic (WSC). No significant differences were observed between groups regarding age or sex distribution. However, cachectic patients presented significantly lower BMI (23.3 vs. 26.8 kg/m2, p = 0.006), lower hemoglobin levels (11.3 vs. 13.3 g/dL, p < 0.0001), and lower serum albumin concentrations (3.4 vs. 3.9 g/dL, p = 0.048). In contrast, CRP levels were significantly higher in the CC group compared with the WSC group (9.0 vs. 6.5 mg/L, p = 0.031). These differences are illustrated in Figure 3.
Table 1.
Sample characteristic. Baseline demographic and laboratory characteristics of the study population. Continuous variables are presented as mean (SD), and categorical variables as frequency and percentage. Comparisons were performed between cachectic (CC) and non-cachectic (WSC) patients.
| Variable | Total (n = 69) | CC (n = 40) | WSC (n = 29) | p-value |
|---|---|---|---|---|
| Age (years) | 63.2 (14.0) | 65.3 (13.8) | 60.2 (14.0) | 0.134 |
| Female, n (%) | 33 (47.8) | 16 (40.0) | 17 (58.6) | 0.149 |
| Male, n (%) | 36 (52.2) | 24 (60.0) | 12 (41.4) | - |
| BMI (Kg/m2) | 24.8 (5.3) | 23.3 (5.1) | 26.8 (5.0) | 0.006 |
| Hemoglobin (g/dL) | 12.1 (2.5) | 11.3 (2.2) | 13.3 (2.4) | <0.0001 |
| CRP (mg/L) | 8.0 (4.8) | 9.0 (4.8) | 6.5 (4.6) | 0.031 |
| Albumin (g/dL) | 3.6 (0.9) | 3.4 (1.0) | 3.9 (0.8) | 0.048 |
Figure 3.
Inflammatory and nutritional biomarkers according to cachexia status. (A) Distribution of serum C-reactive protein (CRP) concentrations. (B) Distribution of serum albumin concentrations. Cachectic patients (CC) presented significantly higher CRP levels and lower albumin concentrations than non-cachectic patients (WSC). Boxes represent the interquartile range, horizontal lines indicate the median, and whiskers represent data dispersion.
No significant differences were observed between right-sided and left-sided colorectal cancer regarding age, sex distribution, CRP concentrations, or albumin levels. Cachexia was more frequently observed among patients with right-sided tumors (70.8%) than among those with left-sided tumors (51.1%), although this difference did not reach statistical significance (p = 0.185).
No significant differences were observed between patients with right-sided and left-sided colorectal cancer regarding age, sex distribution, CRP concentrations, or albumin levels (Table 2). However, cachexia was more frequently observed among patients with right-sided tumors than among those with left-sided tumors (70.8% vs. 51.1%), although this difference did not reach statistical significance (p = 0.185). This distribution is illustrated in Figure 2, which shows the absolute number of cachectic and non-cachectic patients according to primary tumor location.
Table 2.
Right vs. Left Colon. Clinical and laboratory characteristics according to primary tumor location. Comparisons were performed between patients with right-sided colon cancer (CD) and left-sided colon cancer (CE). Continuous variables are presented as mean values and categorical variables as frequency and percentage.
| Variable | Right Colon (CD) n = 24 | Left Colon (CE) n = 45 | p-value |
|---|---|---|---|
| AGE (years) | 60.7 | 64.5 | 0.328 |
| Female, n (%) | 12 (50.0%) | 21 (46.7%) | 0.991 |
| Male, n (%) | 12 (50.0%) | 24 (53.3) | - |
| CC, n (%) | 17 (70.8%) | 23 (51.1%) | 0.185 |
| WSC, n (%) | 7 (29.2) | 22 (48.9) | - |
| CRP (mg/L) | 8.80 | 7.54 | 0.313 |
| Albumin (g/dL) | 3.50 | 3.66 | 0.513 |
Figure 2.
Distribution of cachectic (CC) and non-cachectic (WSC) patients according to primary tumor location. Right-sided tumors were more frequently associated with cachexia (70.8%) than left-sided tumors (51.1%), although the difference did not reach statistical significance (p = 0.185).
Patients who died were significantly older than survivors (68.7 vs. 61.0 years, p = 0.041) (Table 3). No statistically significant differences were observed regarding sex distribution, cachexia status, BMI, hemoglobin, CRP, or albumin levels.
Table 3.
Mortality according to clinical and laboratory characteristics. Clinical and laboratory characteristics according to survival status. Continuous variables are presented as mean values and categorical variables as frequency and percentage. Comparisons were performed between deceased and surviving patients during the follow-up period.
| Variable | Death (n = 19) | Alive (n = 50) | p-value |
|---|---|---|---|
| Age (years) | 68.7 | 61.0 | 0.041 |
| Female, n (%) | 6 (31.6) | 27 (54.0) | 0.013 |
| Male, n (%) | 13 (68.4) | 23 (46.0) | - |
| CC, n (%) | 14 (73.7) | 26 (52.0) | 0.171 |
| WSC, n (%) | 5 (26.3) | 24 (48.0) | - |
| BMI (kg/m2) | 24.94 | 24.75 | 0.895 |
| Hemoglobin (g/dL) | 12.58 | 11.97 | 0.364 |
| CRP (mg/L) | 8.31 | 7.85 | 0.728 |
| Albumin (g/dL) | 3.66 | 3.58 | 0.759 |
Cachectic patients presented significantly lower BMI, hemoglobin and albumin levels, as well as higher CRP concentrations, CRP/albumin ratio, GPS and mGPS scores when compared with non-cachectic patients (Table 4).
Table 4.
Clinical and inflammatory characteristics according to cachexia status. Inflammatory and nutritional characteristics according to cachexia status. Cachectic patients (CC) were compared with non-cachectic patients (WSC). CRP/albumin ratio, Glasgow Prognostic Score (GPS), and modified Glasgow Prognostic Score (mGPS) were evaluated as markers of systemic inflammation and nutritional impairment.
| Variable | CC (n = 40) | WSC (n = 29) | p-value |
|---|---|---|---|
| BMI (kg/m2) | 23.3 | 26.8 | 0.006 |
| Hemoglobin (g/dL) | 11.3 | 13.3 | <0.001 |
| CRP (mg/L) | 9.0 | 6.5 | 0.031 |
| Albumin (g/dL) | 3.4 | 3.9 | 0.048 |
| CRP/Albumin ratio | 3.3 | 1.8 | 0.012 |
| GPS | 1.1 | 0.5 | 0.007 |
| mGPS | 0.9 | 0.3 | 0.003 |
4. Discussion
The present study investigated clinical, inflammatory, and nutritional characteristics of patients with colorectal cancer according to cachexia status and primary tumor location. The main findings were that cachectic patients exhibited significantly lower BMI, hemoglobin, and albumin levels, as well as higher CRP concentrations and worse inflammatory scores (GPS and mGPS). In contrast, no significant differences were observed between right-sided and left-sided colorectal cancer regarding demographic or laboratory characteristics.
The reductions in BMI, hemoglobin, and albumin observed among cachectic patients, together with elevated CRP concentrations, are consistent with the current understanding of cancer cachexia as a multifactorial syndrome characterized by systemic inflammation, progressive nutritional deterioration, and metabolic dysregulation. According to the international consensus proposed by Fearon et al., cancer cachexia results from a complex interaction between reduced nutritional intake and tumor-induced inflammatory responses, leading to ongoing loss of skeletal muscle mass and functional decline. The lower BMI values observed in cachectic patients in the present study reflect this progressive wasting process and support the adequacy of the classification criteria used (3, 15).
Systemic inflammation plays a central role in the pathophysiology of cancer cachexia. Elevated CRP concentrations observed among cachectic patients indicate activation of the acute-phase inflammatory response and may reflect the inflammatory component of nutritional deterioration. Recent evidence has demonstrated that inflammatory biomarkers, particularly CRP and albumin-based indices, are associated with disease progression, treatment response, postoperative complications, and survival outcomes in patients with colorectal cancer and other gastrointestinal malignancies. The significantly higher CRP levels identified in the present study therefore support the concept that systemic inflammation represents a major biological component of cancer cachexia (16–18).
Similarly, serum albumin has been widely recognized as an indicator of both nutritional status and inflammatory burden. Hypoalbuminemia may result from reduced protein synthesis, increased catabolism, and persistent inflammatory activity, all of which are common features of cachexia. In the present study, cachectic patients presented significantly lower albumin concentrations than non-cachectic individuals, reinforcing the close relationship between nutritional deterioration and inflammatory activation. Recent studies have highlighted the prognostic value of albumin and CRP-based biomarkers in colorectal cancer, demonstrating their association with postoperative complications, reduced treatment tolerance, and poorer survival outcomes (16, 17).
The significantly higher GPS and mGPS scores observed among cachectic patients further strengthen the inflammatory profile identified in this cohort. Because both scores combine CRP and albumin measurements, they provide an integrated assessment of systemic inflammation and nutritional status. Recent studies have demonstrated that mGPS is associated with oncological outcomes in rectal cancer and may also serve as a prognostic tool in metastatic colorectal cancer. In this context, the higher GPS and mGPS values identified in cachectic patients suggest a more advanced inflammatory and metabolic impairment, supporting the potential utility of these scores as accessible clinical tools for risk stratification and prognostic assessment (19, 20).
The lower hemoglobin concentrations observed among cachectic patients may also reflect the interaction between chronic inflammation, nutritional deficiency, metabolic dysregulation, and cancer-associated anemia. Cancer cachexia is increasingly recognized as a systemic metabolic disorder involving multilevel alterations in energy metabolism, inflammatory signaling, and inter-organ communication, which may contribute to progressive functional decline and impaired physiological reserve. Previous studies have reported that anemia and low hemoglobin levels are associated with worse prognosis in patients with cancer cachexia, potentially influencing functional status, quality of life, treatment response, and survival (21, 22).
An additional finding of the present study was the association between age and mortality. Patients who died during follow-up were significantly older than survivors, whereas no significant differences were observed regarding cachexia status, BMI, hemoglobin, CRP, or albumin concentrations. Age has consistently been recognized as an important prognostic factor in colorectal cancer, reflecting the combined effects of comorbidities, reduced physiological reserve, frailty, and decreased tolerance to surgical and oncological treatments. Although inflammatory and nutritional biomarkers were associated with cachexia in the present study, age emerged as the only variable significantly associated with mortality, suggesting that patient-related factors may play a particularly important role in long-term outcomes (23).
Although right-sided and left-sided colorectal cancers are known to differ in embryological origin, molecular profile, and tumor biology, no significant differences were observed between the groups in the present study. Recent investigations have reported that right-sided tumors are more frequently associated with older age, female sex, microsatellite instability, and distinct biological behavior. However, these biological differences do not necessarily translate into measurable differences in clinical or laboratory parameters, particularly in smaller cohorts. The absence of significant differences in our study may therefore reflect the limited sample size and predominance of inflammatory and nutritional factors associated with cachexia rather than tumor location itself. Nevertheless, a higher proportion of cachectic patients was observed among individuals with right-sided tumors (70.8% vs. 51.1%), suggesting a potential trend that deserves further investigation in larger cohorts (24, 25).
The present study has some limitations that should be acknowledged. First, its retrospective and cross-sectional design limits causal inference. Second, the relatively small sample size may have reduced the statistical power to detect differences between tumor locations. Finally, the study was conducted at a single institution, which may limit the generalizability of the findings. Nevertheless, important strengths include the availability of detailed clinical, laboratory, inflammatory, nutritional, and quality-of-life data, allowing a comprehensive assessment of cachexia-related characteristics in patients with colorectal cancer.
In conclusion, cachectic patients with colorectal cancer exhibited a distinct inflammatory and nutritional profile characterized by lower BMI, hemoglobin, and albumin levels, as well as higher CRP concentrations and inflammatory scores. These findings reinforce the central role of systemic inflammation in cancer cachexia and support the clinical utility of CRP, albumin, GPS, and mGPS as accessible biomarkers for patient assessment and risk stratification.
4.1. Study limitations
This study has some limitations that should be acknowledged. First, the analysis was conducted in a single university hospital, which may limit the generalizability of the findings to other populations and healthcare settings. Second, the retrospective and cross-sectional design limits causal inference and does not allow the establishment of temporal relationships between cachexia, inflammatory biomarkers, tumor location, and clinical outcomes. Third, the relatively small sample size may have reduced the statistical power to detect differences between right-sided and left-sided colorectal cancer groups.
Another important limitation is the possible incompleteness of medical records, particularly regarding long-term follow-up information. For this reason, a formal survival analysis, such as Kaplan–Meier curves or Cox regression, was not performed, as censoring data were not consistently available for all patients. Therefore, mortality was analyzed only as a confirmed clinical status during follow-up. In addition, the absence of genomic and molecular data prevented a more detailed correlation with molecular subtypes of colorectal cancer, such as microsatellite instability or other tumor-specific biological features.
Despite these limitations, the study presents relevant strengths, including the availability of clinical, anthropometric, laboratory, inflammatory, nutritional, and quality-of-life data. This allowed an integrated evaluation of cachexia-related characteristics in patients with colorectal cancer and supported the identification of a distinct inflammatory and nutritional profile among cachectic patients.
5. Conclusion
Cachectic patients with colorectal cancer exhibited a distinct inflammatory and nutritional profile characterized by lower BMI, hemoglobin, and albumin levels, as well as higher CRP concentrations, CRP/albumin ratio, GPS, and mGPS values. No significant differences were observed between right-sided and left-sided colorectal cancer regarding age, sex distribution, CRP concentrations, or albumin levels, although cachexia was more frequent among patients with right-sided tumors. These findings reinforce the clinical relevance of cachexia as a condition associated with systemic inflammation and nutritional impairment in colorectal cancer patients. Further multicenter studies with larger sample sizes and complete longitudinal follow-up are needed to validate these observations and better clarify their prognostic implications.
Acknowledgments
The authors acknowledge the support of the Sao Paulo Research Foundation (FAPESP), Thematic Project “Cancer is a systemic disease: intertissue communication and cachexia”, grant No. 2024/14108-2.
Funding Statement
The author(s) declared that financial support was received for this work and/or its publication. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.
Footnotes
Edited by: Audrius Dulskas, National Cancer Institute (Lithuania), Lithuania
Reviewed by: Markus Andret Cavalcante Gifoni, Federal University of Ceara, Brazil
Bianca Medici, University of Modena and Reggio Emilia, Italy
Data availability statement
The datasets presented in this article are not readily available because they contain clinical information obtained from medical records and are subject to institutional and ethical restrictions. Requests to access the datasets should be directed to the corresponding author and will be evaluated according to institutional and Research Ethics Committee requirements.
Ethics statement
The studies involving humans were approved by the Research Ethics Committee of the University Hospital of the University of Sao Paulo (HU-USP), Sao Paulo, Brazil (CEP-HU/USP No. 2079/23; CAAE: 70838623.3.3001.0076). The studies were conducted in accordance with local legislation and institutional requirements. The participants provided written informed consent to participate in this study.
Author contributions
AM: Conceptualization, Data curation, Investigation, Methodology, Software, Validation, Visualization, Writing – original draft, Writing – review & editing. PA: Conceptualization, Formal analysis, Supervision, Validation, Writing – review & editing. JJ: Conceptualization, Data curation, Methodology, Writing – original draft, Writing – review & editing. AA: Data curation, Methodology, Software, Validation, Writing – review & editing. MS: Conceptualization, Supervision, Resources, Writing – review & editing. JPO: Supervision, Project administration, Resources, Writing – review & editing.
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author MS declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
Correction Note
This article has been corrected with minor changes. These changes do not impact the scientific content of the article.
Generative AI statement
The author(s) declared that generative AI was used in the creation of this manuscript. Generative AI tools were used for language editing and structural refinement of the manuscript. All scientific content, data analysis, and interpretations were developed and verified by the authors.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
- 1.Gonçalves DC, Gomes SP, Seelaender M. Metabolic, inflammatory, and molecular impact of cancer cachexia on the liver. Int J Mol Sci. (2024) 25:11945. 10.3390/ijms252211945 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Simoes E, Uchida R, Nucci MP, Duran FLS, Lima JDCC, Gama LR, et al. Cachexia alters central nervous system morphology and functionality in cancer patients. J Cachexia Sarcopenia Muscle. (2025) 16(1):e13742. 10.1002/jcsm.13742 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. (2011) 12(5):489–95. 10.1016/S1470-2045(10)70218-7 [DOI] [PubMed] [Google Scholar]
- 4.Sun N, Krauss T, Seeliger C, Kunzke T, Stöckl B, Feuchtinger A, et al. Inter-organ cross-talk in human cancer cachexia revealed by spatial metabolomics. Metab Clin Exp. (2024) 161:156034. 10.1016/j.metabol.2024.156034 [DOI] [PubMed] [Google Scholar]
- 5.Gholamalizadeh H, Zafari N, Velayati M, Fiuji H, Maftooh M, Ghorbani E, et al. Prognostic value of primary tumor location in colorectal cancer: an updated meta-analysis. Clin Exp Med. (2023) 23:4369–83. 10.1007/s10238-023-01120-2 [DOI] [PubMed] [Google Scholar]
- 6.Siegel RL, Miller KD, Goding Sauer A, Fedewa SA, Butterly LF, Anderson JC, et al. Colorectal cancer statistics, 2020. CA Cancer J Clin. (2020) 70(3):145–64. 10.3322/caac.21601 [DOI] [PubMed] [Google Scholar]
- 7.Santos M de O, da Silva de Lima FC, Martins LFL, Oliveira JFP, de Almeida LM, de Cancela MC. Estimativa de incidência de câncer no brasil, 2023-2025. Revista Brasileira de Cancerologia. (2023) 69(1):e-213700. 10.32635/2176-9745.rbc.2023v69n1.3700 [DOI] [Google Scholar]
- 8.Zafari N, Velayati M, Damavandi S, Pourali G, Mobarhan MG, Nassiri M, et al. Metabolic pathways regulating colorectal cancer: a potential therapeutic approach. Curr Pharm Des. (2022) 28(36):2995–3009. 10.2174/1381612828666220922111342 [DOI] [PubMed] [Google Scholar]
- 9.Nitsche U, Stögbauer F, Späth C, Haller B, Wilhelm D, Friess H, et al. Right sided colon cancer as a distinct histopathological subtype with reduced prognosis. Dig Surg. (2016) 33(2):157–63. 10.1159/000443644 [DOI] [PubMed] [Google Scholar]
- 10.Baran B, Mert Ozupek N, Yerli Tetik N, Acar E, Bekcioglu O, Baskin Y. Difference between left-sided and right-sided colorectal cancer: a focused review of literature. Gastroenterology Res. (2018) 11(4):264–73. 10.14740/gr1062w [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Aljama S, Lago EP, Zafra O, Sierra J, Simón D, Santos C, et al. Dichotomous colorectal cancer behaviour. Crit Rev Oncol Hematol. (2023) 189:104067. 10.1016/j.critrevonc.2023.104067 [DOI] [PubMed] [Google Scholar]
- 12.Monteiro dos Santos JE, Campos Araújo M, Marcelo Furtado Passos da Silva C. Overweight is the main behavioral risk factor associated with colorectal cancer mortality in the Brazilian population: an ecological analysis. Sci Rep. (2024) 14(1):28178. 10.1038/s41598-024-79921-y [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Guimarães DP, Mantuan LA, De Oliveira MA, Junior RL, Da Costa AM, Rossi S, et al. The performance of colorectal cancer screening in Brazil: the first two years of the implementation program in barretos cancer hospital. Cancer Prev Res (Phila). (2021) 14(2):241–51. 10.1158/1940-6207.CAPR-20-0179 [DOI] [PubMed] [Google Scholar]
- 14.Ribeiro U, Safatle-Ribeiro AV, Sorbello M, Kishi PHR, Mattar R, Castilho VLP, et al. Implementation of an organized colorectal cancer screening program through quantitative fecal immunochemical test followed by colonoscopy in an urban low-income community: guidance and strategies. Clinics. (2023) 78:100278. 10.1016/j.clinsp.2023.100278 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Aktas A, Lorton CM, Griffin O, Higgins K, Roulston F, Stewart G, et al. Application of the 2011 international consensus cancer cachexia classification in routine oncology dietetic practice: an observational study. Nutr Clin Pract. (2023) 38(4):790–7. 10.1002/ncp.10915 [DOI] [PubMed] [Google Scholar]
- 16.Lee CS. Prognostic prediction of colorectal cancer using the C-reactive protein to albumin ratio: the importance of inflammatory biomarkers and their association with long-term outcomes. Ann Coloproctol. (2023) 39:287–8. 10.3393/ac.2023.00486.0069 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Fagarasan G, Seicean R, Bintintan V, Fagarasan V, Caziuc A, Andras D, et al. The value of preoperative C-reactive protein to albumin ratio as a prognostic biomarker in colon cancer patients. Medicina (Lithuania). (2024) 60(7). 10.3390/medicina60071054 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Li H, Mo Z, Tong G. Value of CRP, albumin, and lymphocyte index in predicting survival of patients with gastrointestinal malignancies: a systematic review and meta-analysis. Front Oncol. (2025) 15:1592794. 10.3389/fonc.2025.1592794 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Shimada A, Matsuda T, Sawada R, Hasegawa H, Yamashita K, Harada H, et al. The modified Glasgow prognostic score is a reliable predictor of oncological outcomes in patients with rectal cancer undergoing neoadjuvant chemoradiotherapy. Sci Rep. (2023) 13(1):17111. 10.1038/s41598-023-44431-w [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Cotan H, Iaciu C, Nitipir C. Role of the modified Glasgow prognostic score (mGPS) as a prognostic factor in metastatic colorectal cancer. Cureus. (2024) 16:e64916. 10.7759/cureus.64916 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Berriel Diaz M, Rohm M, Herzig S. Cancer cachexia: multilevel metabolic dysfunction. Nat Metab. (2024) 6:2222–45. 10.1038/s42255-024-01167-9 [DOI] [PubMed] [Google Scholar]
- 22.Zhang XW, Zhang Q, Song MM, Zhang KP, Zhang X, Ruan GT, et al. The prognostic effect of hemoglobin on patients with cancer cachexia: a multicenter retrospective cohort study. Support Care Cancer. (2022) 30(1):875–85. 10.1007/s00520-021-06486-1 [DOI] [PubMed] [Google Scholar]
- 23.Dunne RF, Crawford J, Smoyer KE, McRae TD, Rossulek MI, Revkin JH, et al. The mortality burden of cachexia or weight loss in patients with colorectal or pancreatic cancer: a systematic literature review. J Cachexia Sarcopenia Muscle. (2024) 15(5):1628–40. 10.1002/jcsm.13510 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Abdel Hamid M, Pammer LM, Oberparleiter S, Günther M, Amann A, Gruber RA, et al. Multidimensional differences of right- and left-sided colorectal cancer and their impact on targeted therapies. NPJ Precis Oncol. (2025) 9:116. 10.1038/s41698-025-00892-y [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Szostek J, Serafin M, Mąka M, Jabłońska B, Mrowiec S. Right-Sided versus left-sided colon cancer—a 5-year single-center observational study. Cancers (Basel). (2025) 17(3):537. 10.3390/cancers17030537 [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets presented in this article are not readily available because they contain clinical information obtained from medical records and are subject to institutional and ethical restrictions. Requests to access the datasets should be directed to the corresponding author and will be evaluated according to institutional and Research Ethics Committee requirements.