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. 2024 Jun;13(12):e7328.
doi: 10.1002/cam4.7328.

CT-determined low skeletal muscle index predicts poor prognosis in patients with colorectal cancer

Yue Feng  1 , Xiao-Hong Cheng  2 , Mei Xu  3 , Rui Zhao  2 , Qian-Yi Wan  2 , Wei-Hua Feng  4 , Hua-Tian Gan  1   5
Affiliations

CT-determined low skeletal muscle index predicts poor prognosis in patients with colorectal cancer

Yue Feng et al. Cancer Med. 2024 Jun.

Abstract

Background: Sarcopenia is highly prevalent among patients with colorectal cancer (CRC). Computed tomography (CT)-based assessment of low skeletal muscle index (SMI) is widely used for diagnosing sarcopenia. However, there are conflicting findings on the association between low SMI and overall survival (OS) in CRC patients. The objective of this study was to investigate whether CT-determined low SMI can serve as a valuable prognostic factor in CRC.

Methods: We collected data from patients with CRC who underwent radical surgery at our institution between June 2020 and November 2021. The SMI at the third lumbar vertebra was calculated using CT scans, and the cutoff values for defining low SMI were determined using receiver operating characteristic curves. Univariate and multivariate analyses were performed to assess the associations between clinical characteristics and postoperative major complications.

Results: A total of 464 patients were included in the study, 229 patients (46.7%) were classified as having low SMI. Patients with low SMI were older and had a lower body mass index (BMI), a higher neutrophil to lymphocyte ratio (NLR), and higher nutritional risk screening 2002 (NRS2002) scores compared to those with normal SMI. Furthermore, patients with sarcopenia had a higher rate of major complications (10.9% vs. 1.3%; p < 0.001) and longer length of stay (9.09 ± 4.86 days vs. 8.25 ± 3.12 days; p = 0.03). Low SMI and coronary heart disease were identified as independent risk factors for postoperative major complications. Moreover, CRC patients with low SMI had significantly worse OS. Furthermore, the combination of low SMI with older age or TNM stage II + III resulted in the worst OS in each subgroup analysis.

Conclusions: CT-determined low SMI is associated with poor prognosis in patients with CRC, especially when combined with older age or advanced TNM stage.

Keywords: colorectal cancer; major complications; overall survival; sarcopenia.

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Conflict of interest statement

There was no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of patients.
FIGURE 2
FIGURE 2
ROC curves of low SMM between (A) Male and (B) Female for the detection of major complications.
FIGURE 3
FIGURE 3
Kaplan–Meier survival curves for the associations between SMM and (A) overall survival (OS); (B) recurrence free survival.
FIGURE 4
FIGURE 4
Survival analysis for the combination of SMM and (A) age; (B) TNM stage.
See this image and copyright information in PMC

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