Abstract
BackgroundTo explore the impact of body composition before neoadjuvant chemoradiotherapy (pre-NCRT) and after neoadjuvant chemoradiotherapy (post-NCRT) on complications, survival, and tumor response in patients with locally advanced rectal cancer (LARC).MethodsPatients with LARC who underwent radical surgery after NCRT between Ja 22nuary 2012 and March 2019 were studied. Body composition parameters, including skeletal muscle area (SMA), muscle density (MD), visceral fat area (VFA), total abdominal fat area (TAFA), and subcutaneous fat area (SFA), was identified at the third lumbar vertebra level on computed tomography (CT). The patients were divided into two groups based on the sex-specific quartile values of SMA, MD, VFA, TAFA, SFA, and body composition change. Patient characteristics, short- and long-term postoperative complications, survival, and tumor response were analyzed.ResultsA total of 122 eligible patients were enrolled. Body composition parameters, except MD, were strongly correlated with BMI (p < 0.001). Pre-NCRT low MD (p = 0.04) and TAFA loss (p = 0.02) were significantly correlated with short- and long-term ileus, respectively. Pre-NCRT low SMA was a significant prognostic factor for both disease-free survival (DFS) (HR 2.611, 95% CI 1.129–6.040, p = 0.025) and cancer-specific survival (CSS) (HR 3.124, 95% CI 1.030–9.472, p = 0.044) in the Cox regression multivariate analysis. Multivariate logistic regression analysis identified post-NCRT SFA (OR 3.425, 95% CI 1.392–8.427, p = 0.007) and SFA loss (OR 3.358, 95% CI 1.214–9.289, p = 0.02) as independent risk factors for tumor regression grade (TRG) and downstaging, respectively.ConclusionPre-NCRT low MD and TAFA loss were related to a high incidence of short- and long-term ileus, respectively. Pre-NCRT low SMA was a significant prognostic factor for CSS and DFS. Post-NCRT SFA and SFA loss were independent risk factors for TRG and downstaging, respectively.
Highlights
To explore the impact of body composition before neoadjuvant chemoradiotherapy and after neoadjuvant chemoradiotherapy on complications, survival, and tumor response in patients with locally advanced rectal cancer (LARC)
Unlike body mass index (BMI), which neglects the role of sex and is unable to differentiate between muscle mass and fat mass or to characterize the distribution of adipose tissue, body composition could reflect the “real” status of cancer patients more precisely [18,19,20]
The inclusion criteria were as follows: [1] pre-neoadjuvant chemoradiotherapy (NCRT) colonoscopy pathology confirming the diagnosis of adenocarcinoma; [2] diagnosis of LARC through pre-NCRT computed tomography (CT) and magnetic resonance imaging (MRI); [3] all patients underwent NCRT followed by radical surgery; and [4] complete inpatient data, including pre- and post-NCRT CT scans and follow-up data
Summary
To explore the impact of body composition before neoadjuvant chemoradiotherapy (pre-NCRT) and after neoadjuvant chemoradiotherapy (post-NCRT) on complications, survival, and tumor response in patients with locally advanced rectal cancer (LARC). Cancer-related inflammation and malnutrition are highly prevalent in cancer patients and are essential predictors of complications, survival, and tumor response [8, 9]. Body composition identified from computed tomography (CT) at the third lumbar cross-section of skeletal muscle and fat area is considered an essential biomarker that reflects both inflammatory and nutritional statuses, and its association with cancer outcomes is gaining attention [16, 17]. Unlike body mass index (BMI), which neglects the role of sex and is unable to differentiate between muscle mass and fat mass or to characterize the distribution of adipose tissue, body composition could reflect the “real” status of cancer patients more precisely [18,19,20]
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