Relationship between the modified Asian Working Group for Cachexia definition and postoperative infectious complications in older patients with colorectal cancer: A propensity score-matched study

Background Cancer cachexia is characterized by systemic inflammation, impaired nutritional status, and reduced muscle function, which may influence postoperative recovery after colorectal cancer surgery. Aim This study investigated the association between a modified Asian Working Group for Cachexia (AWGC) definition and postoperative infectious complications in older patients with colorectal cancer. Methods Patients aged ≥65 years who underwent primary resection for colorectal cancer between January 2024 and May 2025 were analyzed. Because reliable data on recent weight loss and anorexia were not consistently available in this retrospective cohort, the full AWGC criteria could not be applied. Therefore, we used a modified AWGC definition based on objective components: low body mass index (< 21 kg/m 2 ) plus at least one of the low handgrip strength or elevated C-reactive protein (> 0.5 mg/dL). Propensity score matching was used to adjust for confounding factors. Summary Of 111 patients, 29 (26.1%) met the modified AWGC definition. After matching, 26 pairs were included in the analysis. Infectious complications occurred in one patient (3.8%) meeting the modified AWGC definition and three patients (11.5%) not meeting the modified AWGC definition (p = 0.603). In this matched cohort, the modified AWGC definition was not significantly associated with postoperative infectious complications. These exploratory findings should not be interpreted as evidence regarding full AWGC-defined cachexia and should be confirmed in larger prospective studies applying the full AWGC criteria.