Application of Prognostic Models Based on Psoas Muscle Index, Stage, Pathological Grade, and Preoperative Carcinoembryonic Antigen Level in Stage II-III Colorectal Cancer Patients Undergoing Adjuvant Chemotherapy

Abstract

Objective. To investigate the effect of sarcopenia on the prognosis of stage II-III colorectal cancer patients undergoing adjuvant chemotherapy. Methods. A total of 196 stage II-III colorectal cancer patients who received 8 cycles of postoperative chemotherapy were retrospectively analyzed. An abdominal CT acquired at 3-4 weeks after surgery was used to calculate the psoas muscle index. Subsequently, once gender-specific receiver operating characteristic curves were plotted and cut-off values of psoas muscle index were defined, the clinicopathological characteristics and the prognosis of patients with high and low values were compared. Lastly, prognostic models were established based on the independent prognostic factors of relapse-free survival and overall survival identified by COX analysis. Results. Based on the psoas muscle index, the prevalence of sarcopenia was 37.5% among 196 patients. This prevalence has significant correlation with patients’ age and gender. However, it was not related to the AJCC stage, T stage, lymph node metastasis, pathological grade, grade III-IV myelosuppression, or preoperative carcinoembryonic antigen level. In addition, both the relapse-free and the overall survival of patients with low and high psoas muscle indexes were significantly different. COX analysis indicated that the psoas muscle index was an independent prognostic factor. Both the overall survival prognostic model based on patients’ psoas muscle index, stage, pathological grade, and preoperative carcinoembryonic antigen level and the relapse-free survival prognostic model based on patients’ psoas muscle index, pathological grade, and preoperative carcinoembryonic antigen level could accurately predict the prognosis of patients. Conclusion. For stage II-III colorectal cancer patients, the presence of sarcopenia before adjuvant chemotherapy would adversely affect their recurrence-free and overall survival. Prognostic models based on psoas muscle index, stage, pathological grade, and preoperative carcinoembryonic antigen level could accurately predict the prognosis in these patients.

Differences in prognosis and underuse of adjuvant chemotherapy between elderly and non‐elderly patients in stage III colorectal cancer

“…These results suggest that non‐sarcopenic elderly patients selected for AC generally have a better prognosis. The presence of sarcopenia before AC has been associated with a poor prognosis compared with the absence of sarcopenia 28 . This study also showed no benefit of AC in patients with sarcopenia.…”

“…The presence of sarcopenia before AC has been associated with a poor prognosis compared with the absence of sarcopenia. 28 This study also showed no benefit of AC in patients with sarcopenia. In contrast, non‐sarcopenic elderly patients have found AC as useful as non‐elderly patients.…”

“…This study also showed no benefit of AC in patients with sarcopenia. In contrast, non‐sarcopenic elderly patients have found AC as useful as non‐elderly patients 28 . AC is not recommended for sarcopenia in the elderly and may be acceptable for patients without sarcopenia; however, its benefits may be limited.…”

Prognostic Impact of Ectopic Fat Deposition within Psoas Muscle in Stage IV Gastric Cancer Patients Undergoing Systemic Chemotherapy

“…In our previous study, we have reported the prognostic significance of PMI in patients with hepatocellular carcinoma undergoing radiofrequency thermal ablation and pancreatic cancer undergoing systemic chemotherapy 34 , 35 . PMI well predicts prognosis in patients with colorectal cancer 36 . PMI can be helpful for predicting postoperative outcomes in patients with esophageal cancer undergoing surgery 37 .…”

Increased Carcinoembryonic Antigen (CEA) Level Is Highly Associated with Low Skeletal Muscle Mass in Asymptomatic Adults: A Population-Based Study

“…The association between high CEA levels and cancer is widely known in the medical community [ 29 ]. Previous studies have demonstrated that up to one-third of patients with CRC develop sarcopenia [ 30 ]. Despite the frequent coexistence of high CEA levels and LMM in the cancer population, no study has assessed whether this coexistence is mediated by cancer or the possibility of a direct relationship between CEA levels and low muscle mass.…”