Association between bioelectrical impedance analysis and platelet-to-lymphocyte ratio in colorectal cancer

Article information

Korean Journal of Clinical Oncology. 2019;15(1):1-2
Publication date (electronic) : 2019 June 30
doi :
Department of Surgery, Chungnam National University School of Medicine, Daejeon, Korea
Correspondence to: Jin Soo Kim, Department of Surgery, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea, Tel: +82-42-280-8383, Fax: +82-42-257-8024, E-mail:
Received 2019 June 25; Revised 2019 June 26; Accepted 2019 June 27.

It has been well established that loss of fat and skeletal muscle were associated with toxicity after cancer treatment and survival [1,2]. Colorectal cancer patients often experience symptoms such as anorexia, nausea, diarrhea, and obstipation at the time of diagnosis. This may negatively affect body composition as well as influence water and electrolyte balance. Therefore, easy available tools that can be used in the clinic to evaluate and monitor loss of fat and skeletal muscle are necessary. Bioelectrical impedance analysis (BIA) is cheap, noninvasive, and provides rapid results of body composition analysis. It may be a useful tool in the clinic to identify malnourished patients. BIA estimates body composition indirectly. A low-voltage current is passed through the body, whereby impedance (i.e., tissue resistance and reactance) is measured. Impedance data is then utilized in empiric equations to estimate body composition. However, BIA has limited validity in the real practice since it does not take into account the differences in impedance represented by the various body segments [3].

Many studies have reported that systemic inflammation was associated with tumorigenesis and tumor progression via promotion of tumor proliferation, angiogenesis, and migration [4,5]. Based on this theory, several biomarkers of systemic inflammation can be candidates for prognosis of colorectal cancer. Platelet-to-lymphocyte ratio (PLR) is the one of systemic inflammatory biomarkers. This is easily obtained from preoperative routine examination and calculated as peripheral platelet count divided by lymphocyte count, which reflects the host immune response and tumor burden. Recent two meta-analyses demonstrated that elevated PLR was associated with poor prognosis in colorectal cancer patients [6,7]. However, the prognostic value of PLR was not well evaluated in patients with colorectal cancer undergoing curative resection.

In this issue of Korean J Clin Oncol, Song et al. [8] demonstrated that elevated PLR was associated with all indexes related to low fat and some indexes (arm muscle circumference and measured muscle circumference of abdomen) to related to low muscle. However, this association was not found in the female patients in the current study. It is interesting to note that the correlation between the body composition and biomarker of systemic inflammation although prognostic implication was not analyzed. These results might provide the clue of prognostic value of PLR in patients with colorectal cancer undergoing curative resection. Further evaluation is necessary to understand correlation between systemic inflammation and body composition.



No potential conflict of interest relevant to this article was reported.


1. 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;12:489–95.
2. Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 2008;9:629–35.
3. Buchholz AC, Bartok C, Schoeller DA. The validity of bioelectrical impedance models in clinical populations. Nutr Clin Pract 2004;19:433–46.
4. Fichtner-Feigl S, Kesselring R, Strober W. Chronic inflammation and the development of malignancy in the GI tract. Trends Immunol 2015;36:451–9.
5. Diakos CI, Charles KA, McMillan DC, Clarke SJ. Cancer-related inflammation and treatment effectiveness. Lancet Oncol 2014;15:e493–503.
6. Li Z, Xu Z, Huang Y, Zhao R, Cui Y, Zhou Y, et al. Prognostic values of preoperative platelet-to-lymphocyte ratio, albumin and hemoglobin in patients with non-metastatic colon cancer. Cancer Manag Res 2019;11:3265–74.
7. Guo YH, Sun HF, Zhang YB, Liao ZJ, Zhao L, Cui J, et al. The clinical use of the platelet/lymphocyte ratio and lymphocyte/monocyte ratio as prognostic predictors in colorectal cancer: a meta-analysis. Oncotarget 2017;8:20011–24.
8. Song WJ, Kim KE, Bae SU, Jeong WK, Baek SK. Association between body composition measured by bioelectrical impedance analysis and platelet-to-lymphocyte ratio in colorectal cancer. Korean J Clin Oncol 2019;15:7–14.

Article information Continued