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. 2025 Jan 9:11:1464978.
doi: 10.3389/fmed.2024.1464978. eCollection 2024.

Low skeletal muscle mass as a proxy marker of sarcopenia is a risk factor for major complications in older patients undergoing curative colon resections for colon cancer

İsmail Tırnova  1 , Maya Gasimova  2 , Hatice Akay  2 , Çağla Sarıtürk  3 , Aslıhan Güven Mert  4 , Özlem Yenidünya  5 , Feza Yarbuğ Karakayalı  1
Affiliations

Low skeletal muscle mass as a proxy marker of sarcopenia is a risk factor for major complications in older patients undergoing curative colon resections for colon cancer

İsmail Tırnova et al. Front Med (Lausanne). .

Abstract

Introduction: Various reports have confirmed that low skeletal muscle mass, a proxy marker of sarcopenia, can be a risk factor for surgical and oncological outcomes in colon cancer. We aimed to investigate the effects of skeletal muscle mass index (SMMI) on postoperative complications, overall survival (OS), and disease-free survival (DFS) in older patients with colon cancer who underwent elective curative colon resections.

Materials and methods: Patients over 65 years old with stage I-III colon cancer who underwent elective curative colon resections between January 2015 and December 2023 were included in this single-center retrospective longitudinal study. Demographics, comorbidities, laboratory data, pathological features, malignant lymph node ratio (MLNR), OS, and DFS were recorded. Controlling Nutritional Status (CONUT) Score was used to assess the nutritional status. An axial portal-phase image was obtained at the level of the third lumbar vertebra, and muscle areas were calculated. SMMI was calculated by dividing the muscle area (cm2) by the square of the patient's height (m2). Low SMMI was defined as SMMI<41 cm2/m2 in women and < 43 cm2/m2 in men with body mass index (BMI) <25 kg/m2, and as SMMI <53 cm2/m2 in patients with a BMI >25 kg/m2. Postoperative complications were classified according to the Clavien-Dindo system. Univariate and multivariate analyses were performed to investigate the factors related to the postoperative complications, OS and DFS.

Results: In total, 98 cases (mean age 75.2 ± 6.9, 55.1% male) were included in the study. The median follow-up time was 38.3 (0.5-113) months. There were 64 patients (65.3%) in the Low SMMI group and 34 patients (34.7%) in the Normal SMMI group. Logistic regression analysis demonstrated that low SMMI was associated with a higher risk of major complications, with an odds ratio of 5.3 (95% CI, 1.1-20.1; p = 0.037). Cox regression analysis revealed no significant differences in OS and DFS.

Conclusion: Low SMMI as a proxy marker of sarcopenia was found to be an independent risk factor for postoperative major complications. Additional prospective studies are warranted to obtain more reliable results.

Keywords: colon cancer; complication; geriatrics; sarcopenia; skeletal muscle mass index; survival.

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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
Computed tomography images at the L3 vertebral body, revealing the skeletal muscle area (SMA) measurement in two different individuals. (A) SMA = 150.33 cm2 with BMI: 24,7, normal skeletal muscle mass index group; (B) SMA = 150.33 cm2 with BMI: 22,4, low skeletal muscle mass index group.
Figure 2
Figure 2
Flowchart diagram for included and excluded participants.
Figure 3
Figure 3
Kaplan–Meier graphics for overall survival (months).
Figure 4
Figure 4
Kaplan–Meier graphics for disease-free survival (months).
See this image and copyright information in PMC

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