Abstract
BackgroundAlthough skeletal muscle index (SMI) and radiodensity (SMD) are well‐known prognostic factors, the clinical impact of the integrated measure, known as skeletal muscle gauge (SMG), has been limited in patients with colorectal cancer (CRC).Patients and MethodsA total of 727 and 268 patients with CRC at two tertiary centers were included and allocated into the training and test sets, respectively. Preoperative slice computed tomography images of the third lumbar area were evaluated for SMI and SMD. SMG was calculated as SMI × SMD and expressed as an arbitrary unit (AU). The optimal cutoff SMG value was determined to maximize the overall survival (OS) difference between the groups with respect to sex in the training set. The multivariate Cox proportional hazard model evaluated the association of its clinical significance.ResultsWith regard to SMG, 1640 and 1523 AU were identified as cutoff values for males and females, respectively. The patients with low SMG values showed significantly worse 5‐year OS than those with high SMG values in the two datasets (both p < 0.001). In the multivariate analysis, low SMG was identified as an independent poor prognostic factor of OS in the training set (hazard ratio 2.18, 95% confidence interval 1.43–3.32, p < 0.001) and test set (hazard ratio 1.79, 95% confidence interval 1.07–3.00, p = 0.025), whereas SMI and SMD were not.ConclusionSMG acts synergistically to improve its prognostic predictive accuracy as compared with SMI or SMD alone in patients with CRC. Additional research is warranted to define its significance in different ethnic groups.
Highlights
The terminology of sarcopenia was initially used to describe age-a ssociated loss of muscle mass in elderly persons.[1]
The impact of skeletal muscle gauge (SMG), which was defined as the product of skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD), has been recently evaluated.11–14 Shachar et al reported that low SMG was associated with grade 3 or 4 toxicity and more hospitalizations in patients with metastatic breast cancer.[11]
SMG has been suggested as a combination of the two skeletal muscle-related factors, evaluation of the potential prognostic effect of SMG has been limited in patients with colorectal cancer (CRC)
Summary
SMG acts synergistically to improve its prognostic predictive accuracy as compared with SMI or SMD alone in patients with CRC. Additional research is warranted to define its significance in different ethnic groups. KEYWORDS colorectal cancer, myosteatosis, sarcopenia, skeletal muscle gauge, skeletal muscle index, skeletal muscle radiodensity
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