Abstract
BackgroundThe clinical significance of pre-sarcopenia in colorectal cancer obstruction has not yet been described. The present study aimed to determine the short- and long-term oncologic impacts of pre-sarcopenia in obstructive colorectal cancer.MethodsWe retrospectively analyzed 214 patients with obstructive colon cancer between January 2004 and December 2013. Initial staging computed tomography (CT) scans identified pre-sarcopenia and visceral obesity by measuring the muscle and visceral fat areas at the third lumbar vertebra level. Both short-term postoperative and long-term oncologic outcomes were analyzed.ResultsAmong all 214 patients, 71 (33.2%) were diagnosed with pre-sarcopenia. Pre-sarcopenia had a negative oncologic impact in both disease-free survival (DFS) and overall survival (OS), (hazard ratio [HR] = 1.86, 95% confidence interval [CI] 1.04–3.13, p = 0.037, and HR = 1.92, CI 1.02–3.60, p = 0.043, respectively). Visceral adiposity, body mass index (BMI), and neutrophil-lymphocyte ratio (NLR) did not significantly impact DFS and OS.ConclusionPre-sarcopenia is a clinical factor significantly associated with OS and DFS but not with short-term complications in obstructive colorectal cancer. In future, prospective studies should incorporate body composition data in patient risk assessments and oncologic prediction tools.
Highlights
The clinical significance of pre-sarcopenia in colorectal cancer obstruction has not yet been described
The present study aims to determine if the short-term and long-term oncological effects of presarcopenia, diagnosed by L3SMI, may play a decisive role when compared to other factors in obstructive colorectal cancer
Definitions We have defined obstructive colorectal cancer as pathological confirmation of adenocarcinoma originated from the cecum to rectum with clinical symptom of obstruction and radiological finding of obstruction in computed tomography (CT) scan or failure of scope passing beyond cancer lesion
Summary
The clinical significance of pre-sarcopenia in colorectal cancer obstruction has not yet been described. The present study aimed to determine the short- and long-term oncologic impacts of pre-sarcopenia in obstructive colorectal cancer. Sarcopenia is defined as a decrease in skeletal muscle volume and function [1] that has been reported to reflect patients’ frailty. Sarcopenia, especially in obese patients, is not characterized by overall weight loss or decreased body mass index (BMI) alone [5]. Preoperative computerized tomography (CT) scan by assessing the muscle area in the third lumbar vertebra (L3) region [10] appears to be one of the most widely researched topics in retrospective studies to measure skeletal muscle index (SMI) and to define pre-sarcopenia. Pre-sarcopenia is characterized by low muscle mass without impact on muscle strength [11]
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