Abstract
Simple SummaryThe number of colorectal cancer survivors is increasing due to improvements in oncologic outcomes. Therefore, the risks of metachronous cancer and second cancer are also increased, as well as recurrences. The influence of muscle mass measured as sarcopenia on long-term survival has been studied recently in colorectal cancer patients. Sarcopenia is a factor controllable by lifestyle modification and has gained interest more recently. This study showed an influence of changes in sarcopenia on long-term oncologic outcomes in colorectal cancer and suggests a basis for further investigation of body composition factors, including sarcopenia.The effect of perioperative sarcopenic changes on prognosis remains unclear. We conducted a retrospective cohort study with 2333 non-metastatic colorectal cancer patients treated between January 2009 and December 2012 at the Asan Medical Center. The body composition at diagnosis was measured via abdominopelvic computed tomography (CT) using Asan-J software. Patients underwent CT scans preoperatively, as well as at 6 months–1 year and 2–3 years postoperatively. The primary outcome was the association between perioperative sarcopenic changes and survival. According to sarcopenic criteria, 1155 (49.5%), 890 (38.2%), and 893 (38.3%) patients had sarcopenia preoperatively, 6 months–1 year, and 2–3 years postoperatively, respectively. The 5-year overall survival (OS) (95.8% vs. 92.1%, hazard ratio (HR) = 2.234, p < 0.001) and 5-year recurrence-free survival (RFS) (93.2% vs. 86.2%, HR = 2.251, p < 0.001) rates were significantly lower in patients with preoperative sarcopenia. Both OS and RFS were lower in patients with persistent sarcopenia 2–3 years postoperatively than in those who recovered (OS: 96.2% vs. 90.2%, p = 0.001; RFS: 91.1% vs. 83.9%, p = 0.002). In multivariate analysis, postoperative sarcopenia was confirmed as an independent factor associated with decreased OS and RFS. Pre- and postoperative sarcopenia and changes in the condition during surveillance were associated with oncological outcomes.
Highlights
We previously reported that body composition affected the long-term survival of patients with non-metastatic rectal cancer [15]; rectal cancer patients with sarcopenic obesity and a low BMI at diagnosis had a negative association with overall survival (OS)
We showed that body composition was associated with OS, it could not reflect postoperative changes in body composition
We investigated the changes in body composition and their association with oncological outcomes
Summary
Various methods are used to measure muscle mass and strength, with many being proposed for body composition measurement, including assessments at the atomic, molecular, and whole-body levels. Techniques used include bioelectrical impedance analysis, dilution techniques, magnetic resonance imaging, and computed tomography (CT) [1,2]; many centers generally use CT to measure muscle mass. As CT scans are utilized with cross-sectional imaging, enabling measurements at the tissue-system level, they are considered highly accurate for the evaluation of levels of fat, fat-free mass, and skeletal muscle [3,4,5]; the psoas muscle is usually employed to measure skeletal muscle status in patients [6,7]. Many studies have provided evidence of the negative impact of sarcopenia in patients with various types of cancers, such as of the lungs, esophagus, and pancreas [7,8,9]. Postoperative health care during or after surveillance has emerged as an important aspect of treatment, and more patients are in need of postoperative care due to the improved survival in patients with cancer [10]; as survival times increase, so do chances for complications and secondary disease
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