Three-dimensional body composition parameters using automatic volumetric segmentation allow accurate prediction of colorectal cancer outcomes

Abstract

Background: Parameters obtained from two-dimensional (2D) cross-sectional images have been used to determine body composition. However, data from three-dimensional (3D) volumetric body images reflect real body composition more accurately and may be better predictors of patient outcomes in cancer. This study aimed to assess the 3D parameters and determine the best predictive factors for patient prognosis.

Methods: Patients who underwent surgery for colorectal cancer (CRC) between 2010 and 2016 were included in this study. Preoperative computed tomography images were analysed using an automatic segmentation program. Body composition parameters for muscle, muscle adiposity, subcutaneous fat (SF) and abdominal visceral fat (AVF) were assessed using 2D images at the third lumbar (L3) level and 3D images of the abdominal waist (L1-L5). The cut-off points for each parameter were determined using X-tile software. A Cox proportional hazards regression model was used to identify the association between the parameters and the treatment outcomes, and the relative influence of each parameter was compared using a gradient boosting model.

Results: Overall, 499 patients were included in the study. At a median follow-up of 59 months, higher 3D parameters of the abdominal muscles and SF from the abdominal waist were found to be associated with longer overall survival (OS) and disease-free survival (all P < 0.001). Although the 3D parameters of AVF were not related to survival outcomes, patients with a high AVF volume and mass experienced higher rate of postoperative complications than those with low AVF volume (27.4% vs. 18.7%, P = 0.021, for mass; 27.1% vs. 19.0%, P = 0.028, for volume). Low muscle mass and volume (hazard ratio [HR] 1.959, P = 0.016; HR 2.093, P = 0.036, respectively) and low SF mass and volume (HR 1.968, P = 0.008; HR 2.561, P = 0.003, respectively), both in the abdominal waist, were identified as independent prognostic factors for worse OS. Along with muscle mass and volume, SF mass and volume in the abdominal waist were negatively correlated with mortality (all P < 0.001). Both AVF mass and volume in the abdominal waist were positively correlated with postoperative complications (P < 0.05); 3D muscle volume and SF at the abdominal waist were the most influential factors for OS.

Conclusions: 3D volumetric parameters generated using an automatic segmentation program showed higher correlations with the short- and long-term outcomes of patients with CRC than conventional 2D parameters.

Keywords: body composition; colorectal cancer; complication; segmentation; survival.

Figure 1

Flowchart. AI, artificial intelligence; CRT, chemoradiotherapy; CT, computed tomography.

Figure 2

Kaplan–Meier curves for overall survival (OS) and disease‐free survival (DFS) according to muscle mass and volume in the abdominal waist. (A) OS in high versus low muscle mass, (B) DFS in high versus low muscle mass, (C) OS in high versus low muscle volume and (D) DFS in high versus low muscle volume.

Figure 3

Kaplan–Meier curves for overall survival (OS) and disease‐free survival (DFS) according to subcutaneous fat (SF) mass and volume in the abdominal waist. (A) OS in high versus low SF mass, (B) DFS in high versus low SF mass, (C) OS in high versus low SF volume and (D) DFS in high versus low SF volume.

Figure 4

Kaplan–Meier curves for overall survival (OS) and disease‐free survival (DFS) according to abdominal visceral fat (AVF) mass and volume in the abdominal waist. (A) OS in high versus low AVF mass, (B) DFS in high versus low AVF mass, (C) OS in high versus low AVF volume and (D) DFS in high versus low AVF volume.

Figure 5

Gradient boosting model for relative influences of parameters on overall survival: (A) muscle parameters and (B) subcutaneous fat (SF) parameters. 2D, two‐dimensional; 3D, three‐dimensional; NAMA, normal muscle attenuation area; SMD, skeletal muscle density; SMG, skeletal muscle gauge; SMI, skeletal muscle index; TAMA, total abdominal muscle area.