The Prognostic Impact of Preoperative Osteopenia in Patients with Colorectal Cancer

Abstract

BACKGROUND: Osteopenia, a condition in which bone mineral density is lower than normal, is a noted risk factor that leads to a shortened healthy life expectancy. OBJECTIVE: This study aimed to investigate the prognostic impact of preoperative osteopenia in colorectal cancer patients. DESIGN: This was a retrospective study. SETTING: This study was conducted at a university hospital. PATIENTS: A total of 1,086 stage I-III colorectal cancer patients who underwent curative resection. MAIN OUTCOME MEASURES: Osteopenia was evaluated with computed tomography imaging. Overall survival, disease-specific survival, and recurrence-free survival were the primary endpoints. RESULTS: Osteopenia was identified in 300 patients (27.6%). Compared with the non-osteopenia group, the 5-year overall survival (74.0% vs. 93.4%, p < 0.001), disease-specific survival (81.6% vs. 97.2%, p < 0.001), and recurrence-free survival rates (57.1% vs. 88.3%, p < 0.001) were significantly lower in the osteopenia group. Multivariate analyses showed that preoperative osteopenia was significantly associated with worse overall survival (HR: 4.135; 95% CI: 2.963-5.770; p < 0.001), disease-specific survival (HR: 7.673; 95% CI: 4.646-12.675; p < 0.001), and recurrence-free survival (HR: 5.039; 95% CI: 3.811-6.662; p < 0.001). The prognosis of the osteopenia group was poorer than that of the non-osteopenia group in every stage: 5-year overall survival (stage I: 89.4% vs. 96.9%, p = 0.028; stage II: 76.5% vs. 91.9%, p < 0.001; stage III: 56.4% vs. 90.8%, p < 0.001) and 5-year RFS (stage I: 85.4% vs. 96.6%, p = 0.002; stage II: 62.0% vs. 86.5%, p < 0.001; stage III: 26.4% vs. 80.0%, p < 0.001). LIMITATIONS: The main limitations are retrospective single-institutional feature, and races of study population. CONCLUSION: Preoperative osteopenia could be a strong predictive marker for long-term prognosis in colorectal cancer regardless of stage.