Abstract
Body composition performed by computed tomography (CT) impacts on cancer patients’ prognoses and responses to treatment. Myosteatosis has been related to overall survival (OS) and disease-specific survival in colorectal cancer (CRC); however, the independent impact of the association of myosteatosis with prognosis in colon cancer (CC) and rectal cancer (RC) is still unclear. CT was performed at the L3 level to assess body composition features in 227 patients with CRC. Clinical parameters were collected. Overall survival (OS) was the primary outcome, and the secondary outcome was disease-free survival (DFS). Skeletal muscle attenuation and intramuscular adipose tissue area were associated with DFS (p = 0.003 and p = 0.011, respectively) and OS (p < 0.001 and p < 0.001, respectively) in CC patients but not in RC patients. Only the skeletal muscle area was associated with better prognosis related to OS in RC patients (p = 0.009). When CC and RC were analyzed separately, myosteatosis influenced survival negatively in CC patients, worsening DFS survival (hazard ratio [HR], 2.70; 95% confidence interval [CI], 1.07–6.82; p = 0.035) and OS (HR, 5.76; 95% CI, 1.31–25.40; p = 0.021). By contrast, the presence of myosteatosis did not influence DFS (HR, 1.02; 95% CI, 0.52–2.03; p = 0.944) or OS (HR, 0.76; 95% CI, 0.33–1.77; p = 0.529) in RC patients. Our study revealed the interference of myosteatosis in the therapy and survival of patients with CC but not in those with RC, strengthening the value of grouping the two types of cancer in body composition analyses.
Highlights
Cancer is a condition that affects millions of people and is among the leading causes of death worldwide, with increasing number of cases each year
Inclusion criteria were as follows: histologically confirmed Colorectal cancer (CRC) adenocarcinoma; patients submitted to curative-intent surgery; clinical stages (CS) I to III according to the 8th AJCC cancer manual [27]; abdominal Computed tomography (CT) scans performed 3 months before or after the diagnosis and available electronically in the picture archiving and communication system; and availability of key clinical, demographic, and anthropometric data of interest
For CC, most patients had less than 65 years, while most significant rectal cancer (RC) patients with myosteatosis had more than 65 years
Summary
Cancer is a condition that affects millions of people and is among the leading causes of death worldwide, with increasing number of cases each year. Body composition impacts cancer patients’ prognosis, the response to treatment, and the survival of these individuals [3,4,5]. Computed tomography (CT) is an effective and accurate method for identifying body features that may interfere with patient treatment and prognosis [3]; CT scanning is the most suitable method for assessing body composition in cancer patients [6] to predict toxicity, tolerance to treatment, and survival [7, 8]. One of the body composition features that can be identified through CT scan is loss of muscle tissue, which can be caused by reduced muscle fiber number and diameter as well as by fat infiltration and collagen deposit into the muscle [9, 10]. Myosteatosis is strongly related to shorter survival in certain cancer patients [5, 13, 14]
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