949 ‘Host Stage Migration’ in Newly Diagnosed, Operable Colorectal Cancer During the First Wave of the COVID-19 Pandemic – A Multicentre Comparative Cohort Study
L R Brown, E Gardner, J J Thompson, J McGovern, T Abbass, D Dolan, R P Davenport, R S J Boardley, D C McMillan, R J E Skipworth, P O Hendry- Surgery
Abstract
Aim
The COVID-19 pandemic caused immeasurable disruption to cancer pathways across the United Kingdom, resulting in many patients presenting with more advanced stages of disease. This study explores whether migration of ‘host-stage’ was evident amongst patients who underwent resection for colorectal cancer during this period.
Method
Consecutive patients who underwent a potentially curative resection, for colorectal cancer newly diagnosed between 23/03/2020 and 23/12/2020, were identified from prospectively maintained databases. A cohort from the same dates in 2019 were sought for comparison. CT body composition analysis, at the L3 vertebral level, allowed calculation of skeletal muscle index (SMI) and density (SMD). Neutrophil-lymphocyte-ratio (NLR) was selected as a composite marker of systemic inflammation. The primary outcomes of interest were host body composition and systemic inflammatory response.
Results
Overall, 280 patients underwent a colorectal resection during 9-month periods in the COVID-19 pandemic (n = 117) and preceding year (n = 167). Age, ASA, sex, and tumour location were all comparable between cohorts. More patients in the COVID cohort had a T3/4 malignancy (83.6% vs. 67.7%, p = 0.04). Median SMI (42.4 vs. 44.3cm2/m2) and SMD (33.6 vs. 33.1 HU) were similar in COVID and pre-COVID populations. NLR was higher amongst patients during the pandemic (median 3.6, IQR: 2.2-5.8) than those in the previous year (median 3.3, IQR: 2.1-4.6, p = 0.05).
Conclusions
A higher proportion of patients who underwent resection of a colorectal cancer during the COVID pandemic had a locally advanced tumour. While CT-body composition was comparable between cohorts, higher levels of pre-treatment systemic inflammation were evident. This may be suggestive of ‘host-stage’ migration.