Prognostic role of pre-sarcopenia and body composition with long-term outcomes in obstructive colorectal cancer: a retrospective cohort study

Lee, Chul Seung; Won, Dae; Oh, Soon Nam; Lee, Yoon Suk; Lee, In Kyu; Kim, Inho; Choi, Moon Hyung; Oh, Seong Taek

doi:10.21203/rs.3.rs-34165/v3

Cited by 5 publications

(7 citation statements)

References 39 publications

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“…In this cohort study, regarding patients who underwent upfront rectal cancer surgery without NACR, the presence of preoperative sarcopenia assessed at CT scan was an independent prognostic factor for dismal longterm OS and TSS, along with other acknowledged variables such as the tumor stage. Several other studies have reported an association between preoperative skeletal muscle wasting and poor long-term survival in different oncological diseases [5][6][7][8]33] and more specifically in colorectal cancer patients [15,[34][35][36][37][38]. However, all those trials used a combined analysis of colon and rectal cancer patients and this may have generated an ambiguous interpretation regarding the oncologic prognosis since colonic tumors have a better survival than rectal cancers [21][22][23]39].…”

Section: Discussionmentioning

confidence: 99%

Skeletal muscle wasting and long-term prognosis in patients undergoing rectal cancer surgery without neoadjuvant therapy

et al. 2022

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Background Derangement of body composition has been associated with dismal long-term survival in several gastrointestinal cancers including rectal tumors treated with neoadjuvant therapies. The role of specific preoperative anthropometric indexes on the oncologic outcomes of patients undergoing upfront surgery for rectal cancer has not been investigated. The aim of the study is to evaluate the association of body composition and overall survival in this specific cohort. Methods Lumbar computed tomography images, obtained within the 30 days previous to surgery, between January 2009 and December 2016, were used to calculate population-specific thresholds of muscle mass (sarcopenia), subcutaneous and visceral adiposity, visceral obesity, sarcopenic obesity, and myosteatosis. These body composition variables were related with overall survival (OS), tumor-specific survival (TSS), and disease-free survival (DFS). OS, TSS, and DFS were evaluated by the Kaplan-Meier method. Cox regression analysis was used to identify independent predictors of mortality, tumor-specific mortality, and recurrence, and data were presented as hazard ratio (HR) and 95% confidence interval (CI). Results During the study period, 411 patients underwent rectal resection for cancer, and among these, 129 were without neoadjuvant chemoradiation. The median follow-up was 96.7 months. At the end of the follow-up, 41 patients (31.8%) had died; of these, 26 (20.1%) died for tumor-related reasons, and 36 (27.1%) experienced disease recurrence. One-, three-, and five-year OS was 95.7%, 86.0%, and 76.8% for non-sarcopenic patients versus 82.4%, 58.8%, and 40.0% for sarcopenic ones respectively (p < 0.001). Kaplan-Meier survival curves comparing sarcopenic and non-sarcopenic patients showed a significant difference in terms of OS (log-rank < 0.0001). Through multivariate Cox regression, overall mortality risk was associated only with sarcopenia (HR 1.96; 95%CI 1.03–3.74; p = 0.041). Disease stage IV and III (HR 13.75; 95% CI 2.89–65.6; p < 0.001 and HR 4.72; 95% CI 1.06–21.1; p = 0.043, respectively) and sarcopenia (HR 2.62; 95% CI 1.22–5.6; p = 0.013) were independently associated with TSS. The other body composition indexes investigated showed no significant association with prognosis. Conclusions These results support the inclusion of body composition assessment for prognostic stratification of rectal cancer patients undergoing upfront resection.

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Section: Discussionmentioning

confidence: 99%

Skeletal muscle wasting and long-term prognosis in patients undergoing rectal cancer surgery without neoadjuvant therapy

et al. 2022

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“…Regarding the OCRC, CT-based myopenia was significantly associated with obstruction [16]. Lee et al showed that SMI-low status was significantly associated with poor OS and RFS, whereas the status was not associated with postoperative complications in 214 OCRC patients [44]. In their study, SEMS were inserted in 117 (54.7%), stoma was created in 41 (19.2%), transfusion was administered to 107 (50.0%), and emergency surgery was performed in 15 cases (7.0%).…”

Section: Discussionmentioning

confidence: 99%

Impact of Sarcopenia on Postoperative Complications in Obstructive Colorectal Cancer Patients Who Received Stenting as a Bridge to Curative Surgery

Sato

Oikawa

Kakita

et al. 2022

J Anus Rectum Colon

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Objectives: Understanding the relationship between sarcopenia and malignancy is increasingly important since they inevitably affect the aging population. We investigated the clinical significance of sarcopenia in nonmetastatic obstructive colorectal cancer (OCRC) patients who were inserted self-expandable metallic stent and underwent curative surgery. Methods: Plain cross-sectional CT images obtained before stenting were retrospectively analyzed in 92 patients. Muscle volume loss (myopenia) and decreased muscle quality (myosteatosis) were evaluated as skeletal muscle index (SMI) and intramuscular adipose tissue content (IMAC), respectively. Results: This study included 54 men and 38 women, with a median age of 70.5 years. The median interval between SEMS placement and the surgery was 17 days (range, 5-47). There were 35 postoperative complications. The median postoperative hospital stay was 15.5 days (range, 8-77). Twenty-eight patients (41.3%) were classified as SMI-low, and 31 (34.1%) patients were classified as IMAC-high. In multivariate analysis, IMAC-high [hazard ratio (HR) = 7.68, 95% confidence interval (CI) 2.22-26.5, P = 0.001] and right-sided tumor (HR = 5.79, 95% CI 1.36-24.7, P = 0.018) were independent predictors of postoperative complications. IMAC-high (HR = 23.2, 95% CI 4.11-131, P < 0.001) and elevated modified Glasgow prognostic score (mGPS) (HR = 5.85, 95% CI 1.22-28.1, P = 0.027) were independent predictors of infectious complications. Relapse-free survival and overall survival were not significantly different regardless of the SMI or IMAC status. Conclusions: IMAC was associated with postoperative complications and infectious complications. Myosteatosis might be a stronger predictor of postoperative complications than myopenia.

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“…Tumor biomarkers have been widely used in the diagnosis and post-treatment follow-up of patients with CRC [15]. The latest research shows that Pre-sarcopenia is a clinical factor significantly associated with OS and DFS in obstructive colorectal cancer [16]. Traditionally, CEA is one of the tumor biomarkers used to predict recurrence, prognosis, and treatment effect in these patients [17,18].…”

Section: Discussionmentioning

confidence: 99%

A nomogram model for predicting prognosis of obstructive colorectal cancer

Liu²,

Jia

et al. 2021

World J Surg Onc

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Background The prognosis of obstructive colorectal cancer (oCRC) is worse than that of nonobstructive colorectal cancer. However, no previous study has established an individualized prediction model for the prognosis of patients with oCRC. We aimed to screen the factors that affect the prognosis of oCRC and to use these findings to establish a nomogram model that predicts the individual prognosis of patients with oCRC. Methods This retrospective study collected data of 181 patients with oCRC from three medical hospitals between February 2012 and December 2017. Among them, 129 patients from one hospital were used as the training cohort. Univariate and multivariate analyses were used in this training cohort to select independent risk factors that affect the prognosis of oCRC, and a nomogram model was established. The other 52 patients from two additional hospitals were used as the validation cohort to verify the model. Results Multivariate analysis showed that carcinoembryonic antigen level (p = 0.037, hazard ratio [HR] = 2.872 [1.065–7.740]), N stage (N1 vs. N0, p = 0.028, HR = 3.187 [1.137–8.938]; N2 vs. N0, p = 0.010, HR = 4.098 [1.393–12.051]), and surgical procedures (p = 0.002, HR = 0.299 [0.139–0.643]) were independent prognostic factors of overall survival in patients with oCRC. These factors were used to construct the nomogram model, which showed good concordance and accuracy. Conclusion Carcinoembryonic antigen, N stage, and surgical method are independent prognostic factors for overall survival in patients with oCRC, and the nomogram model can visually display these results.

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Prognostic role of pre-sarcopenia and body composition with long-term outcomes in obstructive colorectal cancer: a retrospective cohort study

Cited by 5 publications

References 39 publications

Skeletal muscle wasting and long-term prognosis in patients undergoing rectal cancer surgery without neoadjuvant therapy

Skeletal muscle wasting and long-term prognosis in patients undergoing rectal cancer surgery without neoadjuvant therapy

Impact of Sarcopenia on Postoperative Complications in Obstructive Colorectal Cancer Patients Who Received Stenting as a Bridge to Curative Surgery

A nomogram model for predicting prognosis of obstructive colorectal cancer

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