Introduction
Methods
Patients and ethical approval
Measurement of the psoas muscle index (PMI) and definition of sarcopenia
Statistical analysis
Results
Baseline characteristics
Characteristics | No | Sarcopenia | χ2/t | P | |
---|---|---|---|---|---|
No(N = 365) | Yes(N = 574) | Value | Value | ||
BMI | 22.24 ± 2.98 | 21.52 ± 2.45 | 3.907 | 0.000a | |
Age | 57.76 ± 12.89 | 58.65 ± 12.62 | -1.048 | 0.295 | |
60y | 470(50.1) | 187(51.2) | 283(49.3) | 0.332 | 0.564 |
≥ 60y | 469(49.9) | 178(48.8) | 291(50.7) | ||
Gender | 0.290 | 0.590 | |||
Male | 553(58.9) | 211(57.8) | 342(59.6) | ||
Female | 386(41.1) | 154(42.2) | 232(40.4) | ||
Hypertension | 1.589 | 0.207 | |||
No | 838(89.2) | 321(87.9) | 517(90.1) | ||
Yes | 101(10.8) | 44(12.1) | 57(9.9) | ||
ASA | 4.792 | 0.188 | |||
1 | 258(27.5) | 112(30.7) | 146(25.4) | ||
2 | 585(62.3) | 223(61.1) | 362(63.1) | ||
3 | 92(9.8) | 29(7.9) | 63(11.0) | ||
4 | 4(0.4) | 1(0.3) | 3(0.5) | ||
Charlson Comorbidity Index | 0.986 | 0.805 | |||
No comorbidity (0) | 386(41.1) | 156(42.8) | 230(40.1) | ||
Few comorbidities (1–2) | 451(48.0) | 173(47.4) | 278(48.4) | ||
Moderate number of comorbidities (3–4) | 85(9.1) | 30(8.2) | 55(9.6) | ||
High number of comorbidities (≥ 5) | 17(1.8) | 6(1.6) | 11(1.9) | ||
Weight loss (3 kg in the last 3 months) | 4.526 | 0.033a | |||
No | 515(54.8) | 216(59.2) | 299(52.1) | ||
Yes | 424(45.2) | 149(40.8) | 275(47.9) | ||
Intestinal obstruction | 0.002 | 0.963 | |||
No | 870(92.7) | 338(92.6) | 532(92.7) | ||
Yes | 69(7.3) | 27(7.4) | 42(7.3) | ||
Tumour size | 18.851 | 0.000a | |||
< 5 cm | 480(51.1) | 219(60.0) | 261(45.5) | ||
≥ 5 cm | 459(48.9) | 146(40.0) | 313(54.5) | ||
Location | 1.851 | 0.604 | |||
Rectum | 569(60.6) | 230(63.0) | 339(59.1) | ||
Sigmoid colon | 289(30.8) | 104(28.5) | 185(32.2) | ||
Descending colon | 60(6.4) | 22(6.0) | 38(6.6) | ||
Splenic flexure | 21(2.2) | 9(2.5) | 12(2.1) | ||
Gross morphology | 3.412 | 0.182 | |||
Massive | 306(32.6) | 109(29.9) | 197(34.3) | ||
Ulcerative | 530(56.4) | 209(57.3) | 321(55.9) | ||
Infiltrative | 103(11.0) | 47(12.9) | 56(9.8) | ||
Tumour grading | 0.970 | 0.325 | |||
G2/G3 | 874(93.1) | 336(92.1) | 538(93.7) | ||
G1 | 65(6.9) | 29(7.9) | 36(6.3) | ||
Component | 1.730 | 0.421 | |||
Adenocarcinoma | 899(95.7) | 346(94.8) | 553(96.3) | ||
Mucinous | 32(3.4) | 16(4.4) | 16(2.8) | ||
Siglet-ring carcinoma | 8(0.9) | 3(0.8) | 5(0.9) | ||
Lymphovascular invasion | 2.308 | 0.129 | |||
No | 890(94.8) | 351(96.2) | 539(93.9) | ||
Yes | 49(5.2) | 14(3.8) | 35(6.1) | ||
Perineural invasion | 1.715 | 0.190 | |||
No | 922(98.2) | 361(98.9) | 561(97.7) | ||
Yes | 17(1.8) | 4(1.1) | 13(2.3) | ||
T | 7.720 | 0.052 | |||
T1 | 37(3.9) | 19(5.2) | 18(3.1) | ||
T2 | 160(17.0) | 69(18.9) | 91(15.9) | ||
T3 | 372(39.6) | 151(41.4) | 221(38.5) | ||
T4 | 370(39.4) | 126(34.5) | 244(42.5) | ||
N | 0.129 | 0.937 | |||
N0 | 553(58.9) | 214(58.6) | 339(59.1) | ||
N1 | 244(26.0) | 97(26.6) | 147(25.6) | ||
N2 | 142(15.1) | 54(14.8) | 88(15.3) | ||
AJCC/UICC | 3.063 | 0.216 | |||
I | 162(17.3) | 72(19.7) | 90(15.7) | ||
II | 392(41.7) | 143(39.2) | 249(43.4) | ||
III | 385(41.0) | 150(41.1) | 235(40.9) | ||
CEA level(µg/L) | 0.042 | 0.838 | |||
< 5 | 616(65.6) | 238(65.2) | 378(65.9) | ||
≥ 5 | 323(34.4) | 127(34.8) | 196(34.1) | ||
CA19.9 | 0.002 | 0.962 | |||
< 37 | 811(86.4) | 315(86.3) | 496(86.4) | ||
≥ 37 | 128(13.6) | 50(13.7) | 78(13.6) | ||
Chemotherapy | 0.283 | 0.595 | |||
No | 476(50.7) | 189(51.8) | 287(50.0) | ||
Yes | 463(49.3) | 176(48.2) | 287(50.0) | ||
NC N/Y | 234(50.5)/229(49.5) | 83(47.2)/93(52.8) | 151(52.6)/136(47.4) |
Short-term outcomes
Characteristics | No | Sarcopenia | χ2/t | P | |
---|---|---|---|---|---|
No(N = 365) | Yes(N = 574) | Value | Value | ||
Operation time | 218.27 ± 85.16 | 220.36 ± 86.73 | -0.363 | 0.717 | |
Hospitalization after surgery | 10.95 ± 7.18 | 12.00 ± 8.36 | -2.061 | 0.040a | |
Intraoperative blood transfusion | |||||
No | 828(88.2) | 332(91.0) | 496(86.4) | 4.427 | 0.035a |
Yes | 111(11.8) | 33(9.0) | 78(13.6) | ||
Colostomy | 1.830 | 0.176 | |||
No | 838(89.2) | 332(91.0) | 506(88.2) | ||
Yes | 101(10.8) | 33(9.0) | 68(11.8) | ||
Abdominal infection | 1.277 | 0.258 | |||
No | 914(97.3) | 358(98.1) | 556(96.9) | ||
Yes | 25(2.7) | 7(1.9) | 18(3.1) | ||
C-D I/II/IIIa/IIIb/IVa/IVb/V | 0/24/1/0/0/0/0 | 0/7/0/0/0/0/0 | 0/17/1/0/0/0/0 | ||
Pulmonary infection | 0.197 | 0.657 | |||
No | 924(98.4) | 360(98.6) | 564(98.3) | ||
Yes | 15(1.6) | 5(1.4) | 10(1.7) | ||
C-D I/II/IIIa/IIIb/IVa/IVb/V | 3/6/2/0/0/0/4 | 2/2/1/0/0/0/0 | 1/4/1/0/0/0/4 | ||
Urinary infection | 0.634 | 0.426 | |||
No | 925(98.5) | 361(98.9) | 564(98.3) | ||
Yes | 14(1.5) | 4(1.1) | 10(1.7) | ||
C-D I/II/IIIa/IIIb/IVa/IVb/V | 13/1/0/0/0/0/0 | 4/0/0/0/0/0/0 | 9/1/0/0/0/0/0 | ||
Urinary retention | 3.060 | 0.080 | |||
No | 926(98.6) | 363(99.5) | 563(98.1) | ||
Yes | 13(1.4) | 2(0.5) | 11(1.9) | ||
C-D I/II/IIIa/IIIb/IVa/IVb/V | 4/9/0/0/0/0/0 | 1/1/0/0/0/0/0 | 3/8/0/0/0/0/0 | ||
Ureter injury | 0.753 | 0.385 | |||
No | 934(99.5) | 364(99.7) | 570(99.3) | ||
Yes | 5(0.5) | 1(0.3) | 4(0.7) | ||
C-D I/II/IIIa/IIIb/IVa/IVb/V | 0/0/2/3/0/0/0 | 0/0/0/1/0/0/0 | 0/0/2/2/0/0/0 | ||
Surgical site infection | 4.348 | 0.037a | |||
No | 920(98.0) | 362(99.2) | 558(97.2) | ||
Yes | 19(2.0) | 3(0.8) | 16(2.8) | ||
C-D I/II/IIIa/IIIb/IVa/IVb/V | 6/8/0/5/0/0/0 | 1/1/0/1/0/0/0 | 5/7/0/4/0/0/0 | ||
Abdominal haemorrhage | 3.579 | 0.059 | |||
No | 934(99.5) | 361(98.9) | 573(99.8) | ||
Yes | 5(0.5) | 4(1.1) | 1(0.2) | ||
C-D I/II/IIIa/IIIb/IVa/IVb/V | 0/1/1/1/0/0/2 | 0/1/1/1/0/0/1 | 0/0/0/0/0/0/1 | ||
Postoperative intestinal obstruction | 0.240 | 0.624 | |||
No | 921(98.1) | 357(97.8) | 564(98.3) | ||
Yes | 18(1.9) | 8(2.2) | 10(1.7) | ||
C-D I/II/IIIa/IIIb/IVa/IVb/V | 3/12/0/3/0/0/0 | 1/6/0/1/0/0/0 | 2/6/0/2/0/0/0 | ||
DVT | 0.047 | 0.828 | |||
No | 932(99.3) | 362(99.2) | 570(99.3) | ||
Yes | 7(0.7) | 3(0.8) | 4(0.7) | ||
C-D I/II/IIIa/IIIb/IVa/IVb/V | 0/3/2/0/0/0/2 | 0/2/1/0/0/0/0 | 0/1/1/0/0/0/2 | ||
Anastomotic fistula | 4.915 | 0.027a | |||
No | 889(94.7) | 353(96.7) | 536(93.4) | ||
Yes | 50(5.3) | 12(3.3) | 38(6.6) | ||
C-D I/II/IIIa/IIIb/IVa/IVb/V | 0/9/18/16/0/0/7 | 0/3/4/4/0/0/1 | 0/6/14/12/0/0/6 | ||
Hypoalbuminaemia | 5.216 | 0.022a | |||
No | 814(86.7) | 328(89.9) | 486(84.7) | ||
Yes | 125(13.3) | 37(10.1) | 88(15.3) | ||
30-day mortality | 4.154 | 0.042a | |||
No | 928(98.8) | 364(99.7) | 564(98.3) | ||
Yes | 11(1.2) | 1(0.3) | 10(1.7) | ||
90-day mortality | 4.184 | 0.041a | |||
No | 924(98.4) | 363(99.5) | 561(97.7) | ||
Yes | 15(1.6) | 2(0.5) | 13(2.3) |
Impacts of sarcopenia on chemotherapy-related adverse effects
Adverse effects | Non-sarcopenia(176) | Sarcopenia(287) | χ2 | P | ||||
---|---|---|---|---|---|---|---|---|
0 | 1–2 | 3–4 | 0 | 1–2 | 3–4 | |||
Leukopenia | 99(56.2) | 77(43.8) | 0(0) | 171(59.6) | 115(40.1) | 1(0.3) | 1.177 | 0.555 |
Anemia | 121(68.8) | 55(31.3) | 0(0) | 167(58.2) | 114(39.7) | 6(2.1) | 7.781 | 0.020 |
Thrombocytopenia | 163(92.6) | 13(7.4) | 0(0) | 263(91.6) | 24(8.4) | 0(0) | 0.141 | 0.707 |
Nausea | 77(43.8) | 99(56.2) | 0(0) | 121(42.2) | 166(57.8) | 0(0) | 0.113 | 0.737 |
Vomiting | 163(92.6) | 13(7.4) | 0(0) | 263(91.7) | 23(8.0) | 1(0.3) | 0.680 | 0.712 |
Anorexia | 82(46.6) | 94(53.4) | 0(0) | 130(45.3) | 54(53.7) | 3(1.0) | 1.881 | 0.390 |
Mucositis/Stomatitis | 168(95.5) | 18(4.5) | 0(0) | 258(89.9) | 22(7.7) | 7(2.4) | 6.296 | 0.043 |
Taste alteration (Dysgeusia) | 160(90.9) | 16(9.1) | 0(0) | 264(92.0) | 23(8.0) | 0(0) | 0.164 | 0.685 |
Neuropathy: cranial-smell | 133(75.6) | 43(24.4) | 0(0) | 213(74.2) | 74(25.8) | 0(0) | 0.106 | 0.745 |
Diarrhea | 152(86.4) | 24(13.6) | 0(0) | 243(84.7) | 42(14.6) | 2(0.7) | 1.339 | 0.512 |
Constipation | 145(87.3) | 21(12.7) | 0(0) | 236(82.2) | 51(17.8) | 0(0) | 2.062 | 0.151 |
Fatigue (malaise) | 133(75.6) | 42(23.8) | 1(0.6) | 213(74.3) | 73(25.4) | 1(0.3) | 0.257 | 0.879 |
Mood alteration: anxiety/Depression | 175(99.4) | 1(0.6) | 0(0) | 285(99.3) | 2(0.7) | 0(0) | 0.028 | 0.867 |
Alopecia | 161(91.5) | 15(8.5) | 0(0) | 240(83.6) | 41(14.3) | 6(2.1) | 7.452 | 0.024 |
Neuropathy: sensory | 167(94.9) | 9(5.1) | 0(0) | 274(95.5) | 13(4.5) | 0(0) | 0.082 | 0.774 |
Insomnia | 151(85.8) | 24(13.6) | 1(0.6) | 242(84.4) | 44(15.3) | 1(0.3) | 0.363 | 0.834 |
Long-term outcomes: survival analysis
Characteristic | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
P Value | HR(95.0% CI) | P Value | HR(95.0% CI) | |
Gender | 0.363 | 0.890(0.692–1.144) | ||
Age | 0.003 | 1.448(1.131–1.854) | 0.000 | 1.622(1.258–2.091) |
Tumour size | 0.622 | 1.063(0.833–1.357) | ||
Location | 0.003 | 0.745(0.611–0.907) | 0.001 | 0.714(0.585–0.871) |
Gross morphology | 0.396 | 1.088(0.895–1.322) | ||
Tumour grading | 0.006 | 0.345(0.163–0.732) | ||
Component | 0.000 | 2.504(1.778–3.526) | 0.001 | 1.799(1.263–2.561) |
T | 0.000 | 1.681(1.412–2.001) | 0.012 | 1.309(1.062–1.614) |
N | 0.000 | 2.087(1.799–2.422) | 0.001 | 1.620(1.231–2.131) |
AJCC/UICC | 0.000 | 2.269(1.856–2.774) | ||
Lymphovascular invasion | 0.000 | 3.137(2.117–4.648) | ||
Perineural invasion | 0.000 | 4.311(2.465–7.540) | 0.044 | 1.840(1.017–3.332) |
Chemotherapy | 0.006 | 0.708(0.553–0.906) | ||
CEA | 0.000 | 1.598(1.249–2.044) | ||
CA19.9 | 0.000 | 2.024(1.505–2.722) | 0.029 | 1.423(1.037–1.952) |
Sarcopenia | 0.017 | 1.379(1.060–1.794) | 0.0211 | 1.367(1.049–1.782) |
Characteristic | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
P Value | HR(95.0% CI) | P Value | HR(95.0% CI) | |
Gender | 0.793 | 0.968(0.759–1.234) | ||
Age | 0.030 | 1.305(1.026–1.659) | 0.002 | 1.465(1.145–1.873) |
Tumour size | 0.629 | 1.061(0.835–1.346) | ||
Location | 0.008 | 0.774(0.641–0.934) | 0.002 | 0.743(0.615–0.897) |
Gross morphology | 0.674 | 1.042(0.860–1.263) | ||
Tumour grading | 0.009 | 0.390(0.193–0.787) | ||
Component | 0.000 | 2.195(1.578–3.054) | 0.015 | 1.536(1.088–2.168) |
T | 0.000 | 1.542(1.311–1.813) | ||
N | 0.000 | 2.136(1.848–2.469) | 0.001 | 1.558(1.194–2.034) |
AJCC/UICC | 0.000 | 2.367(1.940–2.889) | ||
Lymphovascular invasion | 0.000 | 3.041(2.079–4.449) | ||
Perineural invasion | 0.000 | 3.878(2.219–6.778) | ||
Chemotherapy | 0.000 | 0.623(0.488–0.794) | ||
CEA | 0.000 | 1.617(1.271–2.056) | 0.023 | 1.339(1.041–1.722) |
CA19.9 | 0.000 | 1.960(1.460–2.631) | 0.026 | 1.421(1.043–1.936) |
Sarcopenia | 0.037 | 1.310(1.017–1.689) | 0.045 | 1.299(1.006–1.677) |