Serum alkaline phosphatase elevation as a preoperative sarcopenic biomarker in digestive cancer: a retrospective...

Preoperative patients diagnosed with sarcopenia typically develop postsurgical complications and have an overall poor prognosis. Some studies have revealed an association of the sarcopenia development mechanism with inflammation; however, the mechanism of preoperative patients with cancer remains unknown. As previous studies have indicated elevated serum alkaline phosphatase (ALP) levels as a chronic inflammation biomarker, we focused on patients with digestive cancer as they experienced chronic inflammation and investigated whether it could be a preoperative sarcopenia marker.

The data from electronic medical records were investigated retrospectively. We included 274 patients diagnosed with digestive cancer at the Department of Gastroenterological Surgery of Yokohama City University Hospital and scheduled for surgery after perioperative sarcopenia screening at our rehabilitation outpatient clinic. We divided the patients into the sarcopenia (SC group; 58 patients) and nonsarcopenia (NSC group; 216 patients without sarcopenia) groups.

The serum ALP level was significantly higher in the SC group (168.4 U/L vs. 100.4 U/L), when accounting for differences in confounders such as age, hepatic cancer, liver dysfunction, and bone fracture in the SC group, showing the correlation between ALP elevation and sarcopenia risk (p-value = 0.0018, odds ratio estimated at 1.0055; confidence interval: 1.0021-1.0090). Laboratory findings also showed clinically meaningful differences in albumin, ALP, and hemoglobin levels, neutrophil-to-lymphocyte ratio, and malnutrition parameters between the groups.

Our findings suggest that serum ALP elevation induced by chronic inflammation is correlated with sarcopenia in preoperative patients with digestive cancer.