Low radiographic muscle density is associated with lower overall and disease-free survival in early-stage colorectal cancer patients

Harm Van Baar,F J B Van Duijnhoven,E Kampman,M J L Bours,M P Weijenberg,A Haringhuizen,J F M Pruijt,R M Winkels,G D Slooter,J J Dronkers,E J Spillenaar Bilgen,J H W De Wilt,M Van Zutphen,B M E Hansson,S Beijer

doi:10.1007/s00432-018-2736-z

Abstract

BackgroundIn cancer patients with a poor prognosis, low skeletal muscle radiographic density is associated with higher mortality. Whether this association also holds for early-stage cancer is not very clear. We aimed to study the association between skeletal muscle density and overall mortality among early-stage (stage I–III) colorectal cancer (CRC) patients. Furthermore, we investigated the association between skeletal muscle density and both CRC-specific mortality and disease-free survival in a subset of the study population.MethodsSkeletal muscle density was assessed in 1681 early-stage CRC patients, diagnosed between 2006 and 2015, using pre-operative computed tomography images. Adjusted Cox proportional hazard models were used to evaluate the association between muscle density and overall mortality, CRC-specific mortality and disease-free survival.ResultsThe median follow-up time was 48 months (range 0–119 months). Low muscle density was detected in 39% of CRC patients. Low muscle density was significantly associated with higher mortality (low vs. normal: adjusted HR 1.91, 95% CI 1.53–2.38). After stratification for comorbidities, the association was highest in patients with ≥ 2 comorbidities (HR 2.11, 95% CI 1.55–2.87). Furthermore, low skeletal muscle density was significantly associated with poorer disease-free survival (HR 1.68, 95% CI 1.14–2.47), but not with CRC-specific mortality (HR 1.68, 95% CI 0.89–3.17) in a subset of the study population.ConclusionIn early-stage CRC patients, low muscle density was significantly associated with higher overall mortality, and worse disease-free survival.

Highlights

In recent years, there has been a growing interest in the influence of skeletal muscle density on cancer prognosis
We investigated the association between skeletal muscle density and CRCspecific mortality and disease-free survival in a subset of the study population
Low skeletal muscle density was significantly associated with higher mortality in patients with zero or one comorbidities, yet this association was even stronger in the

Summary

Introduction

There has been a growing interest in the influence of skeletal muscle (radio-) density on cancer prognosis. The first two studies were performed in European populations and did not show significant associations between skeletal muscle density and overall mortality (van Vugt et al 2018; McSorley et al 2017), CRC-specific mortality (McSorley et al 2017) or disease-free survival (van Vugt et al 2018) in early-stage CRC patients after adjusting for confounding factors. The third study, performed in the US (Kroenke et al 2018) reported that lower skeletal muscle density was associated with higher overall and CRC-specific mortality. Low skeletal muscle density was significantly associated with poorer disease-free survival (HR 1.68, 95% CI 1.14–2.47), but not with CRC-specific mortality (HR 1.68, 95% CI 0.89–3.17) in a subset of the study population. Conclusion In early-stage CRC patients, low muscle density was significantly associated with higher overall mortality, and worse disease-free survival

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