Abstract
The impact of longitudinal anthropometric changes during adjuvant chemotherapy on long-term survival in non-metastatic colon cancer is unclear. Herein, we analyzed the prognostic significance of computed tomography (CT)-measured body composition changes in colon cancer patients who underwent surgery followed by adjuvant FOLFOX (folinic acid, 5-fluorouracil, oxaliplatin) chemotherapy. Data of 167 patients with stage III or high-risk stage II colon cancer were analyzed. Skeletal muscle index (SMI), skeletal muscle radiodensity (SMR), visceral fat index (VFI), subcutaneous fat index (SFI), and total fat index (TFI) changes during chemotherapy were calculated using preoperative and postchemotherapy CT image data. The Cox proportional hazard model was used to determine the correlation between changes in anthropometric values and overall survival (OS). The median changes (%) in SMI, SMR, VFI, SFI, and TFI over 210 days during chemotherapy were 8.7% (p < 0.001), 3.4% (p = 0.001), −19% (p < 0.001), −3.4% (p = 0.936), and −11.9% (p < 0.001), respectively. Cut-off values of changes in SMI (skeletal muscle index change, SMIC) and SMR (skeletal muscle radiodensity change, SMRC) were defined at −2% and −2 Hounsfield units (HU) respectively, whereas those of changes in VFI (visceral fat index change, VFIC), SFI (subcutaneous fat index change, SFIC), and TFI (total fat index change, TFIC) were based on values that provided the largest χ2 on the Mantel–Cox test. Multivariable analysis revealed that low SMR measured on a postchemotherapy CT scan (hazard ratio, HR: 0.32, 95% confidence interval, CI: 0.15–0.70, p = 0.004) and visceral fat loss of at least 46.57% (HR: 0.31, 95% CI: 0.14–0.69, p = 0.004) were independent poor prognostic factors for OS. Severe visceral fat loss during FOLFOX chemotherapy and low skeletal muscle radiodensity measured on postchemotherapy CT scans are associated with poor OS in stage III and high-risk stage II colon cancer patients.
Highlights
Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths worldwide [1].Curative resection is the treatment of choice, and adjuvant chemotherapy is recommended for potentially increasing survival in colon cancer patients diagnosed with stage III and stage II withCancers 2020, 12, 60; doi:10.3390/cancers12010060 www.mdpi.com/journal/cancersCancers 2020, 12, 60 high-risk factors [2]
We identified a total of 214 patients with colon cancer who were treated with adjuvant FOLFOX
Five patients were excluded owing to administration of neoadjuvant chemotherapy (n = 3) and a history of inflammatory bowel disease (n = 2); thirty-three patients were excluded owing to missing data or the sub-optimal quality of preoperative computed tomography (CT) (n = 9) or postchemotherapy CT scans (n = 24)
Summary
Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths worldwide [1].Curative resection is the treatment of choice, and adjuvant chemotherapy is recommended for potentially increasing survival in colon cancer patients diagnosed with stage III and stage II withCancers 2020, 12, 60; doi:10.3390/cancers12010060 www.mdpi.com/journal/cancersCancers 2020, 12, 60 high-risk factors [2]. Curative resection is the treatment of choice, and adjuvant chemotherapy is recommended for potentially increasing survival in colon cancer patients diagnosed with stage III and stage II with. Well-described risk factors to predict mortality after completion of chemotherapy are lacking in these relatively high-risk groups; recommendations for identifying ideal candidates for more intensive follow-up have not been characterized. The impact of skeletal muscle depletion (known as sarcopenia) or decreased skeletal muscle radiodensity (known as myosteatosis) has been investigated in various cancers with respect to chemotherapy- or chemoradiotherapy-induced toxicities or survival [6,7,8,9,10]. Sarcopenia, myosteatosis, and visceral obesity have demonstrated substantial value as prognosticators in a number of studies on various cancers including CRC [11,12,13]. In addition to cross-sectional data-driven analysis, several studies have investigated the impact of skeletal muscle changes during treatment in patients with
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