Influence of Postoperative Changes in Sarcopenia on Long-Term Survival in Non-Metastatic Colorectal Cancer Patients

Abstract

The effect of perioperative sarcopenic changes on prognosis remains unclear. We conducted a retrospective cohort study with 2333 non-metastatic colorectal cancer patients treated between January 2009 and December 2012 at the Asan Medical Center. The body composition at diagnosis was measured via abdominopelvic computed tomography (CT) using Asan-J software. Patients underwent CT scans preoperatively, as well as at 6 months–1 year and 2–3 years postoperatively. The primary outcome was the association between perioperative sarcopenic changes and survival. According to sarcopenic criteria, 1155 (49.5%), 890 (38.2%), and 893 (38.3%) patients had sarcopenia preoperatively, 6 months–1 year, and 2–3 years postoperatively, respectively. The 5-year overall survival (OS) (95.8% vs. 92.1%, hazard ratio (HR) = 2.234, p < 0.001) and 5-year recurrence-free survival (RFS) (93.2% vs. 86.2%, HR = 2.251, p < 0.001) rates were significantly lower in patients with preoperative sarcopenia. Both OS and RFS were lower in patients with persistent sarcopenia 2–3 years postoperatively than in those who recovered (OS: 96.2% vs. 90.2%, p = 0.001; RFS: 91.1% vs. 83.9%, p = 0.002). In multivariate analysis, postoperative sarcopenia was confirmed as an independent factor associated with decreased OS and RFS. Pre- and postoperative sarcopenia and changes in the condition during surveillance were associated with oncological outcomes.

Age as a modifier of the effects of sarcopenia on survival among colon cancer patients after surgery

“…Cox proportional hazards regression analysis identified sarcopenia as an independent factor contributing to worse OS. The findings in this study are consistent with the conclusions in the review by Lee et al 38 that the 5‐year OS (95.8% vs. 92.1%, HR = 2.234, p < 0.001) and recurrence‐free survival (93.2% vs. 86.2%, HR = 2.251, p < 0.001) rates were lower in patients with preoperative sarcopenia). In addition to sarcopenia, age >70 years and alcohol consumption were independent factors for OS.…”

“…A number of studies have been conducted to evaluate the effects of sarcopenia on the survival of colon cancer patients after surgery, but the findings have been inconsistent. Some studies found that sarcopenia was a predictor for worse OS, [29][30][31][32][33][34][35][36][37][38] but some others found that sarcopenia was not associated with OS. [39][40][41] Discrepancies in the prognostic contributions of sarcopenia might be in part due to differences in the methods used to determine sarcopenia.…”

Association between sarcopenia and prognosis of hepatocellular carcinoma: A systematic review and meta-analysis

“…In recent years, the clinical significance of sarcopenia in cancer has attracted increasing attention. The associations between sarcopenia and the prognosis in patients with gastric cancer ( 10 ), colorectal cancer ( 11 ), lung cancer ( 12 ), ovarian cancer ( 13 ), and HCC ( 14 , 15 ) have been investigated. For example, a cohort study revealed that sarcopenic patients with HCC undergoing TACE had a significantly poorer overall survival (OS) than those without sarcopenia (491 vs. 1,291 days, P = 0.017) ( 15 ).…”

Lifestyle interventions after colorectal cancer surgery using a mobile digital device: A study protocol for a randomized controlled trial

“…[ 9 , 10 ] Sarcopenia has also emerged as an important prognostic factor for various cancers and is reported to be associated with a poorer survival outcome in both colon and rectal cancer. [ 11 , 12 ]…”

“…[9,10] Sarcopenia has also emerged as an important prognostic factor for various cancers and is reported to be associated with a poorer survival outcome in both colon and rectal cancer. [11,12] We speculated that regulating a patient's lifestyle after colorectal cancer surgery may help to further improve survival outcomes and also the health-related quality of life (HRQOL). However, this would be difficult to achieve with the routine post operative management protocols used currently in these cases.…”