Loss of skeletal muscle index and survival in patients with metastatic colorectal cancer: Secondary analysis of the phase 3 CAIRO3 trial

Abstract

Background: Low skeletal muscle index (SMI) in metastatic colorectal cancer (mCRC) patients is associated with poor outcomes. The prognostic impact of SMI changes during consecutive palliative systemic treatments is unknown. Methods: This is a retrospective analysis of the phase 3 CAIRO3 study. The CAIRO3 study randomized 557 patients between maintenance capecitabine + bevacizumab (CAP-B) or observation, after six cycles capecitabine + oxaliplatin + bevacizumab

Patterns, Predictors, and Prognostic Value of Skeletal Muscle Mass Loss in Patients with Locally Advanced Head and Neck Cancer Undergoing Cisplatin-Based Chemoradiotherapy

“…Although previous studies have shown that loss of SMM in patients who received cancer treatment [14][15][16]31] had significant prognostic impact on survival, in this study, a loss in SMM showed no prognostic impact for OS nor DFS. This difference may be explained by the heterogeneity in the definition of muscle mass changes, the timing of the follow-up imaging, and the type and stage of cancer and its type of treatment.…”

“…The median time between follow-up imaging and pre-CRT imaging in our study was 6 months (range 5-9). In previous studies conducted in non-HNC cancer patients in which loss of SMM showed to have prognostic value, this interval ranged between 9-27 months [27] and 9-18 weeks [15]. In addition to the difference in time interval between this study and previous studies, there was also a difference in the investigated study population.…”

“…It has also been suggested that patients with low SMM have higher blood levels of cytotoxic agents compared to patients without low SMM, which together with the previous mentioned mechanism may cause a vicious circle of muscle wasting [12]. In addition, various studies in other types of cancers have shown that loss of SMM during systemic chemotherapy is prognostic for decreased survival in patients with several types of cancer including colorectal and pancreatic cancer [14][15][16][17].…”

Change in skeletal muscle index and its prognostic significance in patients who underwent successful conversion therapy for initially unresectable colorectal cancer: observational study

“…10 In the CAIRO-3 trial investigating first-line bevacizumab and oxaliplatin-including regimens for metastatic CRC, a decrease in SMI during the treatment was related to early disease progression and reduced survival. 11 Even in later-line chemotherapy, skeletal muscle loss during regorafenib or trifluridine/ tipiracil was associated with OS in two recent retrospective studies, both of which also showed that only patients who received regorafenib showed a significant reduction in skeletal muscle. 12,13 Regarding resectable stage IV CRC, van Vledder et al reported a correlation between preoperative sarcopenic status and poor RFS or OS after hepatectomy for colorectal liver metastasis.…”

“…8 In addition, several longitudinal studies also found that a reduction in skeletal muscle mass during systemic therapy is related to early disease progression or poor survival in metastatic CRC patients. [9][10][11][12][13] In the non-metastatic setting, a low skeletal muscle index (SMI) or psoas muscle index (PMI) at lumbar levels before surgery led to a poor survival in CRC patients. 14,15 A population-based study revealed that longitudinal decreases in muscle mass and density during the first 1-2 years after diagnosis are related to overall and cancer-specific mortalities in stage I-III CRC.…”