The Impact of Muscle and Adipose Tissue on Long-term Survival in Patients With Stage I to III Colorectal Cancer

Abstract

BACKGROUND: Computed tomography-derived body composition parameters are emerging prognostic factors in colorectal cancer. OBJECTIVE: This study aimed to determine the roles of sarcopenia, myosteatosis, and obesity as independent and overlapping parameters in stage I to III colorectal cancer. DESIGN: This is a retrospective cohort study from a prospectively collected database. Multivariate Cox proportional hazards models were performed to assess the associations between body composition parameters and survival. SETTINGS: All patients were seen in a tertiary care cancer center. PATIENTS: Adult patients with stage I to III colorectal cancer, undergoing curative resection from 2007 to 2009, were included. INTERVENTION: Computed tomography-derived quantification of skeletal muscle and adipose tissues was used to determine population-specific cutoffs for sarcopenia, myosteatosis, and total adiposity. MAIN OUTCOME MEASURES: Primary outcome measures were overall, recurrence-free, and cancer-specific survival. RESULTS: In the 968 patients included, there were a total of 254 disease recurrences and 350 deaths. Body mass index and CT-derived measures of adiposity did not result in worse survival outcomes. Sarcopenia was independently predictive of worse overall (HR, 1.45; 95% CI, 1.16-1.84), recurrence-free (HR, 1.32; 95% CI, 1.00–1.75), and cancer-specific survival (HR, 1.46; 95% CI, 1.09–1.94) in a multivariate model. Myosteatosis was also independently predictive of overall survival (HR, 1.53; 95% CI, 1.19–1.97). In a model considering joint effects of sarcopenia and myosteatosis, the presence of both predicted the worst overall (HR, 2.23; 95% CI, 1.62–3.06), recurrence-free (HR, 1.53; 95% CI, 1.06–2.21), and cancer-specific survival (HR, 2.40; 95% CI, 1.69–3.42) in a multivariate model. LIMITATIONS: The limitations of this study are inherent in retrospective observational studies. CONCLUSIONS: Sarcopenia and myosteatosis are independent predictors of worse survival in stage I to III colorectal cancer, and their joint effect is highly predictive of reduced overall, recurrence-free, and cancer-specific survival. See Video Abstract at http://links.lww.com/DCR/A923.

Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

“…However, although several studies have revealed an association between SM and severe or infectious postoperative complications , a lack of association with severe postoperative complications was found in other studies . Muscle density was found to be associated with long‐term overall survival , in contrast to other studies . For VAT, the association with prolonged LOS showed both positive and negative results .…”

“…This inconsistency is in line with available literature. Low muscle density has been associated with postoperative complications and long‐term survival , although other studies have found no associations with overall or severe postoperative complications and long‐term survival . The same counts for VAT or visceral obesity, which was found to be associated with postoperative complications , LOS , readmission , and 2‐year survival in some studies.…”

“…The current body of evidence shows inconsistent associations between body composition measures and adverse outcomes in patients with CRC. Low SM has been shown to be associated with severe postoperative complications , LOS , dose‐limiting toxicity , and long‐term survival . However, other studies did not show associations between low SM and overall or severe postoperative complications , readmission , and long‐term survival .…”

Tutorial: A Step‐by‐Step Guide (Version 2.0) for Measuring Abdominal Circumference and Skeletal Muscle From a Single Cross‐Sectional Computed‐Tomography Image Using the National Institutes of Health ImageJ

“…In patients with acute and chronic illness, depleted skeletal muscle (SM) mass, also referred to as sarcopenia, is a condition associated with underlying disease processes and adverse outcomes . Imaging technologies like dual‐energy x‐ray absorptiometry and computed tomography (CT) are considered gold‐standard references for body composition assessment in research.…”

Association of Body Composition with Long-Term Survival in Non-metastatic Rectal Cancer Patients

“…Previous studies have reported that the composition and the distribution of skeletal muscle mass and visceral adipose tissue offer prognostic implications in patients with colorectal cancer (CRC) [5][6][7]. Sarcopenia, defined as low muscle mass status, is known to be associated with increased postoperative complications and delayed recovery in various types of cancers including colorectal cancer [4,8,9].…”