Abstract
BackgroundThe impact of body composition on the short- or long-term outcomes of patients with surgically treated advanced rectal cancer after neoadjuvant chemoradiotherapy remains unclear. This study examined the correlation between low skeletal muscle mass and morbidity and survival in patients with advanced lower rectal cancer.MethodsWe enrolled 144 clinical stage II/III patients with advanced lower rectal cancer who underwent neoadjuvant chemoradiotherapy followed by curative resection between 2004 and 2011. The cross-sectional skeletal muscle area at the third lumbar vertebra (L3) level was evaluated by computed tomography before chemoradiotherapy, and this was normalized by the square of the height to obtain the skeletal muscle index. Low skeletal muscle mass was defined as the sex-specific lowest quartile of the L3 skeletal muscle index. The association between low skeletal muscle mass and morbidity, relapse-free survival, or overall survival was assessed.ResultsLow skeletal muscle mass was identified in 37 (25.7%) patients. Age and body mass index were associated with low skeletal muscle mass. By multivariate analysis, we found that low skeletal muscle mass was independently associated with poor overall survival (hazard ratio = 2.93; 95%CI: 1.11–7.71; p = 0.031) and relapse-free survival (hazard ratio = 2.15; 95%CI: 1.06–4.21; p = 0.035), but was not associated with the rate of postoperative complications.ConclusionsLow skeletal muscle mass is an independent negative prognostic factor for relapse-free and overall survival in patients with advanced lower rectal cancer treated with neoadjuvant chemoradiotherapy.
Highlights
Neoadjuvant chemoradiotherapy (NCRT) is the standard of care for patients with advanced lower rectal cancer because of the relatively high risk of local recurrence
We found that low skeletal muscle mass was independently associated with poor overall survival and relapse-free survival, but was not associated with the rate of postoperative complications
Low skeletal muscle mass associated with poor patient prognosis in advanced lower rectal cancer
Summary
Neoadjuvant chemoradiotherapy (NCRT) is the standard of care for patients with advanced lower rectal cancer because of the relatively high risk of local recurrence. Skeletal muscle loss is the pivotal feature of sarcopenia, and it is associated with chemotherapy toxicity, complications following surgery, and a decreased rate of survival in cancer patients [6,7,8,9,10,11,12]. It is worth considering whether skeletal muscle loss could be used to predict morbidity and survival among patients with advanced lower rectal cancer who are treated with NCRT. This study examined the correlation between low skeletal muscle mass and morbidity and survival in patients with advanced lower rectal cancer.
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