Published online Dec 27, 2015. doi: 10.4240/wjgs.v7.i12.370
Peer-review started: July 14, 2015
First decision: September 22, 2015
Revised: October 12, 2015
Accepted: November 10, 2015
Article in press: November 11, 2015
Published online: December 27, 2015
Processing time: 167 Days and 12.9 Hours
Core tip: Early studies had shown a prognostic value of hypoalbuminemia in colorectal cancer. The relationship between albumin levels and survival was more consistent when the former was coupled to C-reactive protein, a classic inflammatory marker, in the modified Glasgow prognostic score (mGPS). This relationship also appeared to be independent of nutrition on multivariate analyses. The superiority of mGPS in predicting survival supports inflammation as the major culprit of poorer outcomes. A number of studies showing an association of lower albumin-to-globulin ratios with poorer survival are also in favor of a tilt towards proinflammatory states as the cause of morbidity and mortality. Cancer cachexia is a downstream consequence of the systemic inflammation brought in by colorectal cancer. In this view, albumin is a negative acute phase reactant rather than a nutritional marker. Interventions aimed to halt cancer cachexia should therefore target inflammation.