Computed tomography-measured body composition and survival in rectal cancer patients: a Swedish cohort study

Abstract

Background The association between body composition and survival in rectal cancer patients is still unclear. Therefore, we aimed to evaluate the impact of computed tomography (CT)-measured body composition on survival in rectal cancer patients, stratifying our analyses by sex, tumour location, tumour stage and radiotherapy. Methods This retrospective cohort study included 173 patients with rectal adenocarcinoma. CT colonography scans at the time of diagnosis were used to assess the skeletal muscle index (SMI) and the visceral adipose tissue area (VAT). The patients were divided into a low or high SMI group and a low or high VAT group according to previously defined cutoff values. Endpoints included cancer-specific survival (CSS) and overall survival (OS). Results In all patients, low SMI was associated with worse CSS (HR, 2.63; 95% CI, 1.35–5.12; P = 0.004) and OS (HR, 3.57; 95% CI, 2.01–6.34; P < 0.001) compared to high SMI. The differences remained significant after adjusting for potential confounders (CSS: adjusted HR, 2.28; 95% CI, 1.13–4.58; P = 0.021; OS: adjusted HR, 3.17; 95% CI, 1.73–5.82; P < 0.001). Low SMI was still related to a poor prognosis after stratifying by sex, tumour location, stage and radiotherapy (P < 0.05). High VAT was associated with better CSS (HR, 0.31; 95% CI, 0.11–0.84; P = 0.022) and OS (HR, 0.40; 95% CI, 0.17–0.97; P = 0.044) compared to low VAT among men with rectal cancer ≤ 10 cm from the anal verge. High VAT was associated with worse CSS (HR, 4.15; 95% CI, 1.10–15.66; P = 0.036) in women with rectal cancer ≤ 10 cm from the anal verge. Conclusions Low SMI was associated with worse survival. High VAT predicted better survival in men but worse survival in women. The results suggest that CT-measured body composition is a useful tool for evaluating the prognosis of rectal cancer patients and demonstrate the need to include the sex and the tumour location in the analyses.

Impact of body composition parameters on radiation therapy compliance in locally advanced rectal cancer: A retrospective observational analysis

“…In our study the survival analyses were performed taking into consideration features related to the patients, tumor, treatment, and body composition: at the multivariate analysis muscular quality, in terms of MD, confirmed its independent prognostic role for OS, even adjusted for age, TRG, and mesorectal fascia involvement (MRF). A very recent study identified low SMI as a strong predictor of worse OS (adjusted HR 3.17; p < 0.001) [28] . Moreover, a meta -analysis included 2,377 patients from 7 studies, identified pre-treatment sarcopenia as an independent predictor for worse OS in patients with rectal cancer (HR 2.37; p = 0.02) [31] .…”

“…Our study showed univariate analysis a worse outcome in terms of OS in sarcopenic obesity (HR 2.83, 95 % CI 1.24–6.45; p = 0.01). Interestingly, a low VAT was identified as a predictor of worse DFS when a subgroup analysis was performed in men, according to the only other paper in the literature that explored this issue, in which the Authors hypothesized a possible explanation in the testosterone role [28] . Prior research has demonstrated that visceral obesity is linked to reduced testosterone levels in men, whereas women with high testosterone levels exhibit a positive association with visceral fat accumulation [41] .…”

“…According to the sex-specific definitions of Fearon et al, low muscle mass was defined as SMI < 52.4 cm 2 /m 2 in men and SMI < 38.5 cm 2 /m 2 in women [27] . For VAT analysis, the low VAT group was defined as VAT < 160 cm 2 for men and VAT < 80 cm 2 for women [28] , [29] .…”

Can AI-based body composition assessment outperform body surface area in predicting dose-limiting toxicities for colonic cancer patients on chemotherapy?

“…For each patient, a trained human grader (author JoY) manually selected one CT slice as the most representative of the L3 in line with the Alberta Protocol ( https://tomovision.com/SarcopeniaHelp/index.html ). This slice referred to as the mid-L3 slice, has generally been considered as the gold standard for analysing body segmentation measures in the majority of CRC studies (Arayne 2023 ; Brown et al 2022a , b ; Kotti 2022 ).…”

Metabolic and histomorphological changes of adipose tissue in cachexia

“…Moreover, additional evidences on the role of changes of WAT in cancer have been obtained by retrospective studies conducted among gastrointestinal cancers and in hematological diseases [35–39,40 ▪ ,41–43]. Also, a systematic review including studies on COPD showed a link between changes in adiposity and cardiovascular diseases [44].…”