Sarcopenia is a Negative Prognostic Factor After Curative Resection of Colorectal Cancer

• Published in: Annals of surgical oncology Vol. 22; no. 8; pp. 2663 - 2668
• Main Authors: Miyamoto, Yuji, Baba, Yoshifumi, Sakamoto, Yasuo, Ohuchi, Mayuko, Tokunaga, Ryuma, Kurashige, Junji, Hiyoshi, Yukiharu, Iwagami, Shiro, Yoshida, Naoya, Yoshida, Megumi, Watanabe, Masayuki, Baba, Hideo
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-08-2015; Springer Nature B.V
• Subjects: Adenocarcinoma - complications; Adenocarcinoma - mortality; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Adult; Age Factors; Aged; Aged, 80 and over; Carcinoembryonic Antigen - blood; Colorectal Cancer; Colorectal Neoplasms - complications; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Disease-Free Survival; Female; Follow-Up Studies; Humans; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Prognosis; Proportional Hazards Models; Radiography; Retrospective Studies; Sarcopenia - diagnostic imaging; Sarcopenia - etiology; Sarcopenia - mortality; Severity of Illness Index; Surgery; Surgical Oncology; Survival Rate; Glasgow Prognostic Score; Skeletal Muscle Index; Curative Resection; Overall Survival; Skeletal Muscle Mass
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-014-4281-6

Background
Skeletal muscle depletion (sarcopenia) is closely associated with limited physical ability and high mortality. This study was performed to evaluate the prognostic significance of skeletal muscle depletion in patients with resectable stage I–III colorectal cancer (CRC).
Methods
We conducted a retrospective analysis of 220 consecutive patients with stage I–III CRC who underwent curative resection. The skeletal muscle cross-sectional area was measured by preoperative computed tomography. The lowest sex-specific quartile of skeletal muscle mass was classified as sarcopenia. Factors contributing to recurrence-free survival (RFS) were analyzed by univariate and multivariate Cox proportional hazard models.
Results
Of 220 patients who met our inclusion criteria, 55 (25 %) had sarcopenia. The median follow-up duration was 41.4 months. Patients with sarcopenia were younger and had higher carcinoembryonic antigen levels than patients without sarcopenia. RFS and overall survival (OS) were significantly shorter in patients with sarcopenia than those without (5-year RFS, 56 vs. 79 %, log-rank
p
 = 0.006; 5-year OS, 68 vs. 85 %, log-rank
p
 = 0.015). Multivariate Cox regression analysis revealed that sarcopenia was independently associated with shorter RFS (hazard ratio [HR] 2.176; 95 % confidence interval [CI] 1.200–3.943;
p
 = 0.010) and OS (HR 2.270; 95 % CI 1.147–4.494;
p
 = 0.019). The influence of sarcopenia on patient outcome was modified by age at surgery (
p
value for interaction = 0.026); sarcopenia was associated with a poor prognosis, especially in young patients (log-rank
p
 < 0.001).
Conclusions
Sarcopenia negatively impacts survival in patients undergoing curative resection for stage I–III CRC.