Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

Abstract

Background Current literature is inconsistent in the associations between computed tomography (CT)‐based body composition measures and adverse outcomes in older patients with colorectal cancer (CRC). Moreover, the associations with consecutive treatment modalities have not been studied. This study compared the associations of CT‐based body composition measures with surgery‐ and chemotherapy‐related complications and survival in older patients with CRC. Materials and Methods A retrospective single‐center cohort study was conducted in patients with CRC aged ≥65 years who underwent elective surgery between 2010 and 2014. Gender‐specific standardized scores of preoperative CT‐based skeletal muscle (SM), muscle density, intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), subcutaneous adipose tissue, IMAT percentage, SM/VAT, and body mass index (BMI) were tested for their associations with severe postoperative complications, prolonged length of stay (LOS), readmission, and dose‐limiting toxicity using logistic regression and 1‐year and long‐term survival (range 3.7–6.6 years) using Cox regression. Bonferroni correction was applied to account for multiple testing. Results The study population consisted of 378 patients with CRC with a median age of 73.4 (interquartile range 69.5–78.4) years. Severe postoperative complications occurred in 13.0%, and 39.4% of patients died during follow‐up. Dose‐limiting toxicity occurred in 77.4% of patients receiving chemotherapy (n = 53). SM, muscle density, VAT, SM/VAT, and BMI were associated with surgery‐related complications, and muscle density, IMAT, IMAT percentage, and SM/VAT were associated with long‐term survival. After Bonferroni correction, no CT‐based body composition measure was significantly associated with adverse outcomes. Higher BMI was associated with prolonged LOS. Conclusion The associations between CT‐based body composition measures and adverse outcomes of consecutive treatment modalities in older patients with CRC were not consistent or statistically significant. Implications for Practice Computed tomography (CT)‐based body composition, including muscle mass, muscle density, and intermuscular, visceral, and subcutaneous adipose tissue, showed inconsistent and nonsignificant associations with surgery‐related complications, dose‐limiting toxicity, and overall survival in older adults with colorectal cancer. This study underscores the need to verify whether CT‐based body composition measures are worth implementing in clinical practice.

Prognostic impact of myosteatosis in patients with colorectal cancer: a systematic review and meta‐analysis

“…By funnel plot, publication bias was detected for univariate analysis (Egger P = 0.004) ( Figure S2A) but not for multivariate analysis (Egger P = 0.125) ( Figure S2B). Studies that did not show significance in the forest plot [32][33][34] in Figure 2 were largely those with no clear cut-off or definition for myosteatosis and which scored very poorly in the QUIPS assessment. For example, in Looijaard et al, 33 muscle density measured in HU without any cut-off for myosteatosis was used for the HR calculation, which yielded an insignificant HR value.…”

“…Most studies were retrospective cohort studies from prospectively maintained databases, with well-defined collection period and detailed description of the patient populations. However, one study 32 did not provide sufficient baseline characteristics of the cohort, and four studies either did not provide clear definition of myosteatosis [32][33][34] or had very small proportion of the study CI, confidence interval; HR, hazard ratio; OS, overall survival; NA, not applicable. Figure 4 Meta-analysis of univariate results reporting impact of (A) sarcopenia and (B) myosteatosis by random effects model in studies that report both findings in the same study cohort.…”

“…Studies adjusted for less or different factors were denoted as 'partly'. 14,27,33,34 Regarding statistical approach, four studies did not include multivariate analyses and were judged as with high potential for this bias. 8,14,32,34 One study was noted as 'partly' for the statistical approach domain 33 as muscle density without cut-off was used in the analysis.…”

“…14,27,33,34 Regarding statistical approach, four studies did not include multivariate analyses and were judged as with high potential for this bias. 8,14,32,34 One study was noted as 'partly' for the statistical approach domain 33 as muscle density without cut-off was used in the analysis. Three studies were judged to be at an overall high risk of bias, [32][33][34] given inadequate definition or measurement of myosteatosis and 'partly/unclear' or high risk of bias for the confounding measurement and statistical approach (Table S2).…”

“…8,14,32,34 One study was noted as 'partly' for the statistical approach domain 33 as muscle density without cut-off was used in the analysis. Three studies were judged to be at an overall high risk of bias, [32][33][34] given inadequate definition or measurement of myosteatosis and 'partly/unclear' or high risk of bias for the confounding measurement and statistical approach (Table S2). The GRADE assessment of studies included in the meta-analysis is provided in Table 3, which gave 'Low' score on the overall certainty of evidence as there were no randomized controlled trial studies and mostly retrospective studies.…”