An investigation of body composition in relation to clinical outcomes and immune response in patients undergoing colorectal cancer surgery

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Title: An investigation of body composition in relation to clinical outcomes and immune response in patients undergoing colorectal cancer surgery
Authors: Malietzis, Georgios
Item Type: Thesis or dissertation
Abstract: Colorectal cancer (CRC), the second leading cause of cancer mortality in the UK, is on the rise. Cancer research often focuses on the molecular biology of a tumour, whereas the importance of the biology and condition of the tumour host - the patient - has been underappreciated. The aim of my thesis was to examine the assumption that a systemic (S) and local inflammatory response (IR) is related to the host Body Composition (BC) and also associated with clinical outcomes in patients treated for CRC. Chapter 4 concluded that specific BC profiles such, as the presence of myopenia was an independent predictor of poor survival. Chapter 5 determined the role of the neutrophil to lymphocyte ratio as a prognostic marker for patients with CRC undergoing curative resection. Chapter 6 used CT image analysis to confirm a strong relationship between SIR and muscle depletion in patients with CRC. In Chapter 7, laparoscopy and moderate preoperative SIR favoured preservation and restoration of muscle mass, postoperatively in patients treated for CRC. In Chapter 8.1 through flow cytometry analysis, it was shown that, in a selected group of CRC patients when compared to healthy controls, the circulating DCs were more activated and potentially lymph node homing. Chapter 8.2 built on this knowledge and confirmed associations between the DC phenotype and the disease and host’s BC characteristics. Chapter 9 examined the relationship of local IR with BC and its prognostic utility for CRC outcomes. Results suggested that CCR7 positive cell density at the tumor margin might be a novel prognostic biomarker to predict outcomes in patients with CRC. Overall this thesis highlights the importance of determining the BC profile and the IR of patients undergoing CRC treatment and this may lead to early identification of high-risk patients, allowing early optimisation and ultimately improving their outcomes.
Content Version: Open Access
Issue Date: Sep-2015
Date Awarded: Sep-2016
URI: http://hdl.handle.net/10044/1/58284
Supervisor: Knight, Stella
Blakemore, Alex
Department: Department of Medicine
Publisher: Imperial College London
Qualification Level: Doctoral
Qualification Name: Doctor of Philosophy (PhD)
Appears in Collections:Medicine PhD theses



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