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. 2022 Jan 27:9:796601.
doi: 10.3389/fnut.2022.796601. eCollection 2022.

Impact of Body Composition During Neoadjuvant Chemoradiotherapy on Complications, Survival and Tumor Response in Patients With Locally Advanced Rectal Cancer

Zhenzhen Liu  1 , Siyi Lu  1 , Yuxia Wang  2 , Xinyi Lin  1 , Peng Ran  2 , Xin Zhou  1 , Wei Fu  1 , Hao Wang  2
Affiliations

Impact of Body Composition During Neoadjuvant Chemoradiotherapy on Complications, Survival and Tumor Response in Patients With Locally Advanced Rectal Cancer

Zhenzhen Liu et al. Front Nutr. .

Abstract

Background: To explore the impact of body composition before neoadjuvant chemoradiotherapy (pre-NCRT) and after neoadjuvant chemoradiotherapy (post-NCRT) on complications, survival, and tumor response in patients with locally advanced rectal cancer (LARC).

Methods: Patients with LARC who underwent radical surgery after NCRT between Ja 22nuary 2012 and March 2019 were studied. Body composition parameters, including skeletal muscle area (SMA), muscle density (MD), visceral fat area (VFA), total abdominal fat area (TAFA), and subcutaneous fat area (SFA), was identified at the third lumbar vertebra level on computed tomography (CT). The patients were divided into two groups based on the sex-specific quartile values of SMA, MD, VFA, TAFA, SFA, and body composition change. Patient characteristics, short- and long-term postoperative complications, survival, and tumor response were analyzed.

Results: A total of 122 eligible patients were enrolled. Body composition parameters, except MD, were strongly correlated with BMI (p < 0.001). Pre-NCRT low MD (p = 0.04) and TAFA loss (p = 0.02) were significantly correlated with short- and long-term ileus, respectively. Pre-NCRT low SMA was a significant prognostic factor for both disease-free survival (DFS) (HR 2.611, 95% CI 1.129-6.040, p = 0.025) and cancer-specific survival (CSS) (HR 3.124, 95% CI 1.030-9.472, p = 0.044) in the Cox regression multivariate analysis. Multivariate logistic regression analysis identified post-NCRT SFA (OR 3.425, 95% CI 1.392-8.427, p = 0.007) and SFA loss (OR 3.358, 95% CI 1.214-9.289, p = 0.02) as independent risk factors for tumor regression grade (TRG) and downstaging, respectively.

Conclusion: Pre-NCRT low MD and TAFA loss were related to a high incidence of short- and long-term ileus, respectively. Pre-NCRT low SMA was a significant prognostic factor for CSS and DFS. Post-NCRT SFA and SFA loss were independent risk factors for TRG and downstaging, respectively.

Keywords: body composition; complications; prognosis; rectal cancer; tumor response.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study.
Figure 2
Figure 2
Change of skeletal muscle area (A), muscle density (B), visceral fat area (C), total abdominal fat area (D), subcutaneous fat area (E) during NCRT. Q1, Q2, Q3, and Q4 have represented the highest quartile, 50–75%, 25–50%, and lowest quartile, respectively.
Figure 3
Figure 3
Correlation among hemoglobin and pre-NCRT skeletal muscle area (SMA) (A), post-NCRT SMA (B), pre-NCRT visceral fat area (VFA) (C), subcutaneous fat area (SFA) loss (D). The *symbol indicates p < 0.05 and **symbol indicates p < 0.01.
Figure 4
Figure 4
Comparison of DFS and CSS between the different status of body composition in LARC patients. (A) Kaplan–Meier analysis for DFS rate between normal and pre-NCRT low SMA groups in LARC patients (p = 0.029). (B) Kaplan–Meier analysis for the CSS rate between normal and pre-NCRT low SMA groups in LARC patients (p = 0.028). (C) Kaplan–Meier analysis for CSS rate between normal and pre-NCRT low MD groups in LARC patients (p = 0.048). (D) Kaplan–Meier analysis for the CSS rate between normal and post-NCRT low MD in LARC patients (p = 0.016).
Figure 5
Figure 5
Forrest plot of unadjusted logistic regression to assess the discrimination ability of body composition for tumor TRG and downstaging.
See this image and copyright information in PMC

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