Colon cancer-induced sarcopenia: clinical and radiological correlations

Abstract

Background. The course of colon cancer (CC) is burdened in many patients with elderly and senile age, the presence of severe comorbidities, and complications of the malignancy. The complex treatment for advanced colon tumors also requires the search for predictors appropriate for routine clinical practice.
 Aim. To study the prevalence of sarcopenia (SP) in CC and assess the relationship of SP with the immediate treatment outcomes.
 Materials and methods. A retro-prospective assessment of cachexia and SP according to clinical and radiological criteria and their relationship to postoperative complications was performed in 679 patients. The mean age was 65±10.7 years. Group 1 included 181 patients who received drug therapy for common types of CC. Group 2 included 498 patients who underwent elective colon resections for cancer. The presence of SP was determined by threshold values for skeletal muscle area at the LIII level, averaged to the patient's height squared. To do this, the data from abdominal computed tomography performed for 1 month or less before the start of antitumor treatment were analyzed. The threshold criteria of Prado, Martin, and the European Working Group on Sarcopenia in Older People (EWGSOP2) were compared.
 Results. The SP prevalence was 64% according to the Prado criteria for stages I–II, 66% for stage III, and 73.4% for stage IV; according to the Martin criteria, 63.1%, 62.3%, and 68%, respectively, and according to the EWGSOP2 criteria 22.7%, 26.9%, and 32%, respectively. In general, SP was noted according to the Prado criteria in 70.2% of men and 61.4% of women, according to the Martin criteria in 55.8% of men and 71.9% of women, and according to the EWGSOP2 criteria in 27% of men and 22.9% of women. Sarcopenic obesity was identified in 10.1% of patients. In group 1, there was a statistically significant correlation (p0.001) between the presence of SP and poor overall survival of patients, with the Martin criteria showing the most significant correlation. In group 2, an equally strong correlation between the presence of SP according to the Prado criteria and postoperative mortality was found.
 Conclusion. In CC, SP is detected in more than half of patients before the start of antitumor treatment, being an unfavorable prognostic factor for overall survival and a predictor of death after surgical treatment. Timely diagnosis and treatment of SP can improve the CC therapy outcome.