Age‐Dependent Prognostic Significance of Preoperative Transthyretin After Curative Resection for Stage I–III Colorectal Cancer
- 1Department of Gastroenterological Surgery, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
- 2Division of Translational Research and Advanced Treatment Against Gastrointestinal Cancer Kumamoto University Kumamoto Japan
Abstract
Background: Preoperative malnutrition and systemic inflammation are established determinants of adverse outcomes in colorectal cancer (CRC). Transthyretin (TTR), a rapid‐turnover hepatic protein, reflects both nutritional and inflammatory status; however, its clinical utility may be influenced by age‐ and sex‐related variability. This study evaluated the prognostic significance of preoperative TTR in patients undergoing curative resection for stage I–III CRC.
Methods: A retrospective cohort of 536 patients who underwent curative resection for stage I–III CRC between 2014 and 2024 at a single institution was analyzed. Sex‐specific TTR cutoffs were derived using survival classification and regression tree analysis (20.9 mg/dL for men; 16.95 mg/dL for women), and patients were stratified into low‐ and high‐TTR groups. The primary endpoint was recurrence‐free survival (RFS). Survival outcomes were assessed using Kaplan–Meier analysis, multivariable Cox proportional hazards modeling, and age‐stratified analyses.
Results: Preoperative TTR levels were lower in women and demonstrated a progressive decline with increasing age. Patients with low TTR exhibited significantly inferior RFS compared with those with high TTR (log‐rank p < 0.0001). In multivariable analysis, low preoperative TTR remained an independent predictor of worse RFS (HR 2.407, 95% CI 1.625–3.566; p < 0.001). Age‐stratified analyses demonstrated that the prognostic impact of low TTR was most pronounced in younger patients and progressively attenuated with advancing age.
Conclusions: Preoperative TTR represents an independent prognostic biomarker following curative resection for stage I–III CRC. Its prognostic utility is age‐dependent, with greatest relevance in younger patients, supporting interpretation within an age‐ and sex‐specific framework.
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BibTeX
@article{kawata2026agedependent,
title = {{Age‐Dependent Prognostic Significance of Preoperative Transthyretin After Curative Resection for Stage I–III Colorectal Cancer}},
author = {Ayane Kawata and Yuji Miyamoto and Hiro Nakamura and Takahiko Akiyama and Kota Arima and Katsuhiro Ogawa and Yukiharu Hiyoshi and Masaaki Iwatsuki},
journal = {Annals of Gastroenterological Surgery},
year = {2026},
month = jul,
doi = {10.1002/ags3.70258},
url = {https://doi.org/10.1002/ags3.70258},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Age‐Dependent Prognostic Significance of Preoperative Transthyretin After Curative Resection for Stage I–III Colorectal Cancer
AU - Ayane Kawata
AU - Yuji Miyamoto
AU - Hiro Nakamura
AU - Takahiko Akiyama
AU - Kota Arima
AU - Katsuhiro Ogawa
AU - Yukiharu Hiyoshi
AU - Masaaki Iwatsuki
PY - 2026
DA - 2026/07/31
JO - Annals of Gastroenterological Surgery
DO - 10.1002/ags3.70258
UR - https://doi.org/10.1002/ags3.70258
AB - Background: Preoperative malnutrition and systemic inflammation are established determinants of adverse outcomes in colorectal cancer (CRC). Transthyretin (TTR), a rapid‐turnover hepatic protein, reflects both nutritional and inflammatory status; however, its clinical utility may be influenced by age‐ and sex‐related variability. This study evaluated the prognostic significance of preoperative TTR in patients undergoing curative resection for stage I–III CRC. Methods: A retrospective cohort of 536 patients who underwent curative resection for stage I–III CRC between 2014 and 2024 at a single institution was analyzed. Sex‐specific TTR cutoffs were derived using survival classification and regression tree analysis (20.9 mg/dL for men; 16.95 mg/dL for women), and patients were stratified into low‐ and high‐TTR groups. The primary endpoint was recurrence‐free survival (RFS). Survival outcomes were assessed using Kaplan–Meier analysis, multivariable Cox proportional hazards modeling, and age‐stratified analyses. Results: Preoperative TTR levels were lower in women and demonstrated a progressive decline with increasing age. Patients with low TTR exhibited significantly inferior RFS compared with those with high TTR (log‐rank p < 0.0001). In multivariable analysis, low preoperative TTR remained an independent predictor of worse RFS (HR 2.407, 95% CI 1.625–3.566; p < 0.001). Age‐stratified analyses demonstrated that the prognostic impact of low TTR was most pronounced in younger patients and progressively attenuated with advancing age. Conclusions: Preoperative TTR represents an independent prognostic biomarker following curative resection for stage I–III CRC. Its prognostic utility is age‐dependent, with greatest relevance in younger patients, supporting interpretation within an age‐ and sex‐specific framework.
SN - 2475-0328
ER -