Factors Contributing to Cancer-Related Muscle Wasting During First-Line Systemic Treatment for Metastatic Colorectal Cancer

Abstract

BackgroundIncreasing evidence indicates that loss of muscle mass is associated with adverse outcomes in metastatic colorectal cancer. Here, we investigate which demographic, lifestyle- (smoking), tumor-, and treatment-related factors are associated with muscle loss in patients with metastatic colorectal cancer during first-line palliative systemic treatment.MethodsData from 300 patients with computed tomography scans both at start and after six initial cycles of capecitabine plus oxaliplatin and bevacizumab was used (CAIRO3). From computed tomography, muscle mass normalized for stature (skeletal muscle index [SMI]) was calculated. A priori-selected variables were tested using multivariable linear regression models (P values ≤.05). Two models were developed: Model 1 contained variables measured at start and Model 2 contained variables assessed after initial therapy.ResultsIn Model 1, loss of SMI was statistically significantly associated with a higher initial SMI (−0.32%, 95% confidence interval [CI] = −0.45% to −0.19% per unit increase in initial SMI), smoking status (−2.74%, 95% CI = −5.29% to −0.19% for smokers), and interval of metastases (−3.02%, 95% CI = −5.50% to −0.53%) for metachronous vs synchronous metastases), and primary tumor resection was statistically significantly associated with a gain in SMI (2.17%, 95% CI = 0.13% to 4.21% for resection vs no resection). In Model 2, loss of SMI was statistically significantly associated with response to capecitabine plus oxaliplatin and bevacizumab (−2.48%, 95% CI = −4.33% to −0.62% for stable disease vs partial/complete response).ConclusionsOur results highlight, given the association of sarcopenia and survival, that patients with higher SMI should not be ignored. In addition, smoking is a potentially modifiable factor associated with muscle loss. The association between smoking and muscle loss might relate to worse clinical outcomes in smokers with metastatic colorectal cancer.

S184: preoperative sarcopenia is associated with worse short-term outcomes following transanal total mesorectal excision (TaTME) for rectal cancer

“…Although there is currently conflicting evidence on whether prehabilitation programs in colorectal surgery consistently improve outcomes, this debate may be due to the heterogeneity of existing programs and lack of patient customization [48,49]. As, several studies have shown some benefit to transdisciplinary prehabilitation programs (i.e., physical therapy, diet optimization) in the reversal of sarcopenia, increased utilization of such programs should be considered prior to the initiation of rectal cancer treatment [50][51][52].…”

Dual impact from coincide potential complications of cancer therapy and sarcopenia: a narrative review

“…It has been recognized that cancer patients with sarcopenia have a poor prognosis regarding various malignancies, such as lung, stomach, pancreas, and colorectal cancers alongside different complications associated with cancer treatment [17,18]. In addition, long-term outcomes and overall survival are significantly shorter while death rates are more frequently observed in cancer patients with sarcopenia submitted to oncological therapy [19], as reported in studies by Blauwhoff-Buskermolen et al [20], Liu et al [21], Ma et al [22], Paireder et al [23], Järvinen et al [24], Choi et al [25], Jung et al [26], Miyamoto et al [27], Derksen et al [28], Go et al [29], Prado et al [30] and Rutten et al [31].…”

Sarcopenia in Metastatic Colorectal Carcinoma

“…V rámci studie CAIRO3 byla provedena analýza 1 355 CT skenů 450 pacientů (81 % ze všech zařazených). SMM byla hodnocena ve čtyřech časových bodech: před zahájením léčby 1. linie, v době randomizace k udržovací léčbě nebo observaci, při první a druhé progresi [17,32,34].…”

“…Rizikovým faktorem je také kouření. Naopak resekce primárního nádoru a metachronní metastatické onemocnění byly spojeny s nižším rizikem sarkopenie [32].…”