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. 2022 Sep 18;14(18):4521.
doi: 10.3390/cancers14184521.

Body Composition as a Predictor of the Survival in Anal Cancer

Ahmed Allam Mohamed  1   2 , Kathrin Risse  1   2 , Jennifer Stock  1   2 , Alexander Heinzel  2   3 , Felix M Mottaghy  2   3   4 , Philipp Bruners  2   5 , Michael J Eble  1   2
Affiliations

Body Composition as a Predictor of the Survival in Anal Cancer

Ahmed Allam Mohamed et al. Cancers (Basel). .

Abstract

Background and aim: Sarcopenia and body composition parameters such as visceral and subcutaneous adipose tissue and visceral-to-subcutaneous adipose tissue ratio have been shown to be relevant biomarkers for prognosis in patients with different types of cancer. However, these findings have not been well studied in anal cancer to date. Therefore, the aim of this study was to evaluate the prognostic value of different body composition parameters in patients undergoing radiation therapy for the treatment of anal cancer with curative intent. Material and Methods: After approval by the institutional ethical committee, we retrospectively identified 81 patients in our local registry, who received radical intensity-modulated radiotherapy for the management of anal squamous cell cancer (ASCC). Clinical information, including body mass index (BMI), survival, and toxicities outcome, were retrieved from the local hospital registry. Based on the pre-therapeutic computer tomography (CT), we measured the total psoas muscle area, visceral adipose tissue area (VAT), subcutaneous adipose tissue area (SAT), and visceral-to-subcutaneous adipose tissue area ratio (VSR). In addition to the classical prognostic factors as T-stage, N-stage, gender, and treatment duration, we analyzed the impact of body composition on the prognosis in univariate and multivariate analyses. Results: Sarcopenia was not associated with increased mortality in anal cancer patients, whereas increased BMI (≥27 kg/m2) and VSR (≥0.45) were significantly associated with worsened overall survival and cancer-specific survival in both univariate and multivariate analyses. VSR-not BMI-was statistically higher in males. Sarcopenia and VSR ≥ 0.45 were associated with advanced T-stages. None of the body composition parameters resulted in a significant increase in treatment-related toxicities. Conclusion: BMI and visceral adiposity are independent prognostic factors for the survival of patients with anal cancer. Measurements to treat adiposity at the time of diagnosis may be needed to improve the survival outcomes for the affected patients.

Keywords: anal malignancies; biomarker; gastrointestinal tumors; obesity.

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Conflict of interest statement

All authors declare that they have no competing interest.

Figures

Figure 1
Figure 1
Scatter plot diagrams showing the Correlation between SAT and VAT (a); between BMI and SAT (b); between BMI and VAT (c); between BMI and VSR (d); between BSA and BMI (e); and BSA and VSR (f), black dots represent measurements from 81 patients, the solid line represents the regression line and grey shadow represents the confidence interval.
Figure 2
Figure 2
(a) Boxplot diagram showing BMI in both males “M” and females “F” and diagram (b) showing VSR in males “M” and females “F”.
Figure 3
Figure 3
The Kaplan–Meier survival curves showing the difference in OS and CSS for patients with ASCC based on BMI (≥27 vs. <27 kg/m2) (a,b); based on VSR (≥0.45 vs. <0.45) (c,d); based on Sarcopenia (yes vs. no) (e,f); and tumor stage (advanced vs. early) (g,h), in red and blue, respectively.
Figure 4
Figure 4
COX hazard regression analysis of Sarcopenia, BMI, VSR, and tumor stage for CSS (a), OS (b), LRFS (c), and DFS (d), showing the hazard ratio for each parameter, *: p value < 0.05, **: p value ≤ 0.005.
See this image and copyright information in PMC

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