Osteopenia and sarcopenia, features of the aging process, are recognized as major health problems in an aging society. This study investigated the prognostic impact of osteosarcopenia, the coexistence of osteopenia and sarcopenia, in older adults undergoing curative resection for colorectal cancer. MethodsWe retrospectively reviewed data of older adults aged 65-98 years who had undergone curative resection for colorectal cancer. Osteopenia was evaluated by bone mineral density measurement in the midvertebral core of the 11th thoracic vertebra on preoperative computed tomography images.Sarcopenia was evaluated by measuring the skeletal muscle cross-sectional area at the third lumbar vertebra level. Osteosarcopenia was de ned as the coexistence of osteopenia and sarcopenia. We explored the relationship of preoperative osteosarcopenia with the disease-free and overall survival after curative resection. ResultsAmong the 325 patients included, osteosarcopenia had signi cantly lower overall survival rates than those with osteopenia (P<0.01) or sarcopenia alone (P=0.036). In the multivariate analysis, male sex (P=0.045), C-reactive protein-to-albumin ratio (P<0.01), osteosarcopenia (P<0.01), pathological T4 stage (P=0.023), and pathological N1/N2 stage (P<0.01) were independent predictors of disease-free survival, while age (P<0.01), male sex (P=0.049), C-reactive protein-to-albumin ratio (P<0.01), osteosarcopenia (P<0.01), pathological T4 stage (P=0.036), pathological N1/N2 stage (P<0.01), and carbohydrate antigen 19-9 (P=0.041) were independent predictors of overall survival. ConclusionsOsteosarcopenia was a strong predictor of poor outcomes in older adults undergoing curative resection for colorectal cancer, suggesting an important role of osteosarcopenia in an aging society.

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Purpose Osteopenia and sarcopenia, features of the aging process, are recognized as major health problems in an aging society. This study investigated the prognostic impact of osteosarcopenia, the coexistence of osteopenia and sarcopenia, in older adults undergoing curative resection for colorectal cancer. Methods We retrospectively reviewed data of older adults aged 65-98 years who had undergone curative resection for colorectal cancer. Osteopenia was evaluated by bone mineral density measurement in the midvertebral core of the 11th thoracic vertebra on preoperative computed tomography images. Sarcopenia was evaluated by measuring the skeletal muscle cross-sectional area at the third lumbar vertebra level. Osteosarcopenia was defined as the coexistence of osteopenia and sarcopenia. We explored the relationship of preoperative osteosarcopenia with the disease-free and overall survival after curative resection. Results Among the 325 patients included, osteosarcopenia had significantly lower overall survival rates than those with osteopenia (P<0.01) or sarcopenia alone (P=0.036). In the multivariate analysis, male sex (P=0.045), C-reactive protein-to-albumin ratio (P<0.01), osteosarcopenia (P<0.01), pathological T4 stage (P=0.023), and pathological N1/N2 stage (P<0.01) were independent predictors of disease-free survival, while age (P<0.01), male sex (P=0.049), C-reactive protein-to-albumin ratio (P<0.01), osteosarcopenia (P<0.01), pathological T4 stage (P=0.036), pathological N1/N2 stage (P<0.01), and carbohydrate antigen 19-9 (P=0.041) were independent predictors of overall survival. Conclusions Osteosarcopenia was a strong predictor of poor outcomes in older adults undergoing curative resection for colorectal cancer, suggesting an important role of osteosarcopenia in an aging society.

Purpose: Cancer cachexia, a complex multifactorial syndrome associated with sarcopenia, negatively affects quality of life and survival in patients with several cancers. We aimed to develop a new score for cachexia assessment and evaluate its effectiveness in classification of patients undergoing radical resection for colorectal cancer. Methods: This study included 396 patients who underwent radical resection for Stage I–III colorectal cancer. To develop the Cancer Cachexia Score (CCS), we analyzed predictive factors of cachexia status related to the development of sarcopenia and incorporated significant factors into the score. We then evaluated the relationship between CCS and overall survival after radical resection for colorectal cancer. Results: As body mass index (P < 0.001), prognostic nutritional index (P = 0.005), and tumor volume (P < 0.001) were significantly associated with the development of sarcopenia, these factors were included in CCS. Using CCS, 221 (56 %), 98 (25 %), and 77 (19 %) patients were diagnosed with mild, moderate, and severe cancer cachexia, respectively. In multivariate analysis, severe CCS (P < 0.001), N stage 1–2 (P < 0.001), and occurrence of postoperative complications (P = 0.007) were independent predictors of disease-free survival. Age ≥ 65 years (P = 0.009), severe CCS (P < 0.001), and N stage 1–2 (P < 0.001) were independent predictors of overall survival. Conclusions: CCS may be a strong predictor of poor survival in patients with colorectal cancer, suggesting the usefulness of CCS in classifying patients according to their cachexia status and predicting postoperative prognosis.

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