Computed tomography-measured bone mineral density as a surrogate marker of survival after resection of colorectal liver metastases

Abstract

Background: Osteopenia/osteoporosis, characterized by low bone mineral density (BMD), is a potential prognostic factor in cancer patients. We conducted a retrospective single-institution study to evaluate the prognostic impact of preoperative low BMD on colorectal liver metastases (CRLM) in patients undergoing liver resection.Methods: BMD was assessed in 281 patients undergoing initial liver resection for CRLM by analyzing the preoperative computed tomography (CT) images at the level of the eleventh thoracic vertebra as the region of interest. Survival outcomes were compared between the two groups divided by the median BMD value and prognostic factors after surgery were assessed. Propensity score-based inverse probability weighting (IPW) was applied to adjust for between-group differences in baseline characteristics.Results: The low BMD group had significantly more older patients (≥75 years) (P=0.01) and a higher incidence of bilobar metastases (P=0.005) than the normal BMD group. After IPW adjustment, overall survival (OS) was significantly poorer (P=0.02) and recurrence-free survival was slightly poorer (P=0.05) in the low BMD group than in the normal BMD group. IPW-adjusted regression analysis revealed that low BMD was independently associated with an adverse OS (hazard ratio, 1.42; 95% CI, 1.04-1.93; P=0.03), in addition to other factors such as tumor number, extrahepatic disease, preoperative carcinoembryonic antigen level (≥5 ng/mL), and right-sided primary tumor location.Conclusions: Preoperative CT-measured low BMD can serve as a surrogate marker of adverse OS in CRLM patients undergoing liver resection. Prevention and early intervention for osteopenia/osteoporosis may be suggested for these patients.

Prognostic value of preoperative low bone mineral density in patients with digestive cancers: a systematic review and meta-analysis

“…After contacting the original authors, we included an additional study. Finally, 11 studies (2230 patients) were included for the meta-analysis [23][24][25][26][27][28][29][30][31][32][33].…”

“…Table 1 shows the characteristics of the included studies [23][24][25][26][27][28][29][30][31][32][33]. Of the 11 studies, three studies focused on pancreatic cancer [25,26,28], two on colorectal liver metastases [29,30], two on extrahepatic cholangiocarcinoma [24,32], one on esophageal cancer [31], one on colon cancer [33], and two on hepatocellular carcinoma [23,27]. Six studies adopted cutoff values for BMD from previous studies [23,25,33,[27][28][29], while the other five studies adopted their own cutoff values [24,26,[30][31][32].…”

“…Of the 11 studies, three studies focused on pancreatic cancer [25,26,28], two on colorectal liver metastases [29,30], two on extrahepatic cholangiocarcinoma [24,32], one on esophageal cancer [31], one on colon cancer [33], and two on hepatocellular carcinoma [23,27]. Six studies adopted cutoff values for BMD from previous studies [23,25,33,[27][28][29], while the other five studies adopted their own cutoff values [24,26,[30][31][32]. There was no statistically significant difference in the association between low BMD and normal BMD in five studies where patients received neoadjuvant chemotherapy [25,26,[29][30][31].…”

“…Six studies adopted cutoff values for BMD from previous studies [23,25,33,[27][28][29], while the other five studies adopted their own cutoff values [24,26,[30][31][32]. There was no statistically significant difference in the association between low BMD and normal BMD in five studies where patients received neoadjuvant chemotherapy [25,26,[29][30][31]. The risk of bias for study participation, study attrition, outcome measurements, and statistical analysis were low.…”

“…The risk of bias for study participation, study attrition, outcome measurements, and statistical analysis were low. The risk of bias for prognostic factor measurement was moderate in five studies as they had their own BMD cutoff values [24,26,[30][31][32].…”