Prognostic significance of osteopenia in patients with colorectal cancer: A retrospective cohort study

Abstract

Aim We examined the prognostic impact of osteopenia on the long‐term outcomes of patients with colorectal cancer after laparoscopic colectomy along with other nutritional factors, including sarcopenia or the Glasgow Prognostic Score. Methods This retrospective cohort study analyzed the data of 230 patients with stage Ⅰ–Ⅲ colorectal cancers who underwent surgical resection between November 2010 and December 2015. Osteopenia and sarcopenia were evaluated by measuring the average pixel density in the mid‐vertebral core of the 11th thoracic vertebra on enhanced computed tomography and the psoas muscle mass area at the third lumbar vertebra, respectively. The overall survival and disease‐free survival rates were analyzed using Cox proportional hazards model and Kaplan–Meier curves with the log‐rank test. Results Osteopenia was identified in 43 patients (18.7%). Univariate analysis showed that the disease‐free survival rate was significantly worse in patients with stage II–III cancers, vascular invasion, carcinoembryonic antigen (CA) >5.0 ng/mL, CA19‐9 > 37.0 U/mL, sarcopenia, and osteopenia (all P < .01). Multivariate analysis revealed that stage II–III cancers (P = .01), vascular invasion (P = .01), carcinoembryonic antigen >5.0 (P < .01), and osteopenia (P < .01) were significant independent disease‐free survival predictors. In univariate analysis, the overall survival rate significantly decreased in patients with stage II–III cancers (P = .03), carcinoembryonic antigen >5.0 (P < .01), CA19‐9 > 37.0 (P < .01), sarcopenia (P < .01), and osteopenia (P < .01). Multivariate analysis indicated that carcinoembryonic antigen >5.0 (P = .04), CA19‐9 > 37.0 (P = .05), and osteopenia (P < .01) were significant independent predictors of overall survival. Conclusion Preoperative osteopenia could be a strong predictor of long‐term outcomes in patients undergoing resection for colorectal cancer.

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].…”

“…Table 1 shows the characteristics of the included studies [ 23 – 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 ].…”

Significance of osteopenia in elderly patients undergoing emergency gastrointestinal surgery

“… 21 In gastroenterological surgery, the association between low BMD and poor prognosis has been shown in patients with cancer using BMD assessment of the midvertebral core at Th11. 12 , 13 , 14 The use of CT‐derived BMD values for osteopenia diagnosis remains controversial. Therefore, we determined the BMD cutoff value using the ROC curve and observed results that were similar to previous studies, which is that low BMD was correlated with advanced age.…”