Impact of low skeletal muscle mass and density on short and long-term outcome after resection of stage I-III colorectal cancer
Introduction
Colorectal cancer is one of the leading causes of cancer-related death with an estimated total cancer burden of 7% and a great impact on disability-adjusted life years worldwide [1], [2]. Recently, there has been a rising interest in the impact of low skeletal muscle mass and density on short and long term outcome in cancer patients [3]. Skeletal muscle depletion may result from cancer, as part of the cancer-cachexia syndrome, and ageing (i.e. sarcopenia, the involuntary age-related loss of skeletal muscle mass and strength) [4].
The impact of low skeletal muscle mass and density on postoperative outcome (i.e. postoperative complications and mortality) [2], [5], [6], [7], [8] and chemotherapy toxicity [9], [10], [11] has frequently been described in colorectal cancer patients. Furthermore, low skeletal muscle mass and density are prognostic factors in patients undergoing surgery for colorectal metastases [12], [13] or chemotherapy for metastatic colorectal cancer [9], [14]. However, its effect on long-term outcome in patients with stage I-III colorectal cancer has been reported in only a few studies [15], [16], [17].
Therefore, the aim of the present study was to investigate the association between low skeletal muscle mass and density on both short and long-term outcome in patients undergoing colorectal cancer surgery with curative intent in a multi-center prospective study.
Section snippets
Study design and patient selection
Patients were selected from the MATCH-study, an ongoing prospective observational cohort study enrolling patients undergoing curative resection for primary colorectal cancer in seven centers in the region of Rotterdam, the Netherlands [18], [19]. The study was approved by the IRB and all patients provided written informed consent (MEC-2007-088). All aspects listed in the STROBE guidelines were followed, and the paper was written accordingly [20].
All patients with stage I-III colorectal cancer,
Patient characteristics
A total of 981 patients with stage I-III colorectal cancer were included in the MATCH-study in the given period. CT examinations were not available in 157 patients and BMI could not be retrieved from 8 patient charts, leaving a total cohort of 816 patients. The median time between CT and surgery was 33 (IQR 22–47) days. Baseline characteristics of included and excluded patients did not differ significantly, besides type of surgery (open surgery 41.9% versus 52.1%, p = 0.032), and number of
Discussion
In this study, we found that low skeletal muscle mass and density were predictors for short-term outcome (i.e. postoperative complications, mortality, LOS, and discharge status) in patients undergoing curative intent resection of colorectal cancer, but not for long-term outcome (i.e. overall, cancer-specific, and disease-free survival).
Our results are in line with the study of Sabel et al., which also found an association between psoas density and short-term, but not long-term outcome, after
Conflict of interest statement
The authors declare to have no conflict of interest with regard to the manuscript “Impact of Low Skeletal Muscle Mass and Density on Short and Long-Term Outcome after Resection of Stage I-III Colorectal Cancer”.
References (45)
- et al.
Lower muscle density is associated with major postoperative complications in older patients after surgery for colorectal cancer
Eur J Surg Oncol
(2016) - et al.
Sarcopenia negatively impacts short-term outcomes in patients undergoing hepatic resection for colorectal liver metastasis
HPB (Oxford)
(2011) - et al.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies
Lancet (Lond Engl)
(2007) - et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987) - et al.
Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study
Lancet Oncol
(2008) - et al.
Frailty as a predictor of surgical outcomes in older patients
J Am Coll Surg
(2010) - et al.
Long-term changes in physical capacity after colorectal cancer treatment
J Geriatr Oncol
(2015) - et al.
A viscerally driven cachexia syndrome in patients with advanced colorectal cancer: contributions of organ and tumor mass to whole-body energy demands
Am J Clin Nutr
(2009) - et al.
Sarcopenia is associated with an increased inflammatory response to surgery in colorectal cancer
Clin Nutr
(2016) - et al.
The relationship between tumour stage, systemic inflammation, body composition and survival in patients with colorectal cancer
Clin Nutr
(2018)
ROMANA 3: a phase 3 safety extension study of anamorelin in advanced non-small cell lung cancer (NSCLC) patients with cachexia
Ann Oncol
Improving the outcomes in oncological colorectal surgery
World J Gastroenterol
Systematic review of sarcopenia in patients operated on for gastrointestinal and hepatopancreatobiliary malignancies
Br J Surg
Cachexia versus sarcopenia
Curr Opin Clin Nutr Metab Care
Sarcopenia, as defined by low muscle mass, strength and physical performance, predicts complications after surgery for colorectal cancer
Colorectal Dis
Simple psoas cross-sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications
Colorectal Dis
Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery
Br J Cancer
Sarcopenia is highly prevalent in patients undergoing surgery for gastric cancer but not associated with worse outcomes
J Surg Oncol
Loss of muscle mass during chemotherapy is predictive for poor survival of patients with metastatic colorectal cancer
J Clin Oncol
Effect of muscle mass on toxicity and survival in patients with colon cancer undergoing adjuvant chemotherapy
Support Care Cancer
Sarcopenia is linked to treatment toxicity in patients with metastatic colorectal cancer
Nutr Cancer
Body composition and outcome in patients undergoing resection of colorectal liver metastases
Br J Surg
Cited by (71)
Evaluation of sarcopenia biomarkers in older patients undergoing major surgery for digestive cancer. SAXO prospective cohort study
2023, European Journal of Surgical Oncology