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. 2025 Jun 23;20(6):e0324719.
doi: 10.1371/journal.pone.0324719. eCollection 2025.

Clinical impact of low bone mineral density in patients with colorectal cancer liver metastasis undergoing hepatectomy

Yuichi Aoki  1 , Atsushi Miki  1 , Yasunaru Sakuma  1 , Jun Watanabe  1 , Takehiro Kagaya  1 , Makiko Tahara  1 , Takumi Teratani  1 , Kazuhiro Endo  1 , Hideki Sasanuma  1 , Wataru Nishimura  2 , Hisanaga Horie  1 , Joji Kitayama  1 , Naohiro Sata  1 , Hironori Yamaguchi  1
Affiliations

Clinical impact of low bone mineral density in patients with colorectal cancer liver metastasis undergoing hepatectomy

Yuichi Aoki et al. PLoS One. .

Abstract

Background: This study aimed to elucidate the clinical impact of osteopenia on the recurrence of colon cancer liver metastases.

Methods: Patients with colon cancer liver metastases (N = 186) undergoing hepatectomy at Jichi Medical University Hospital between March 2006 and March 2020 were examined retrospectively. Computed tomography (CT) scans on the 11th vertebra within 3 months of surgery assessed bone mineral density (BMD). Age-adjusted BMD determined osteopenia presence. Kaplan-Meier method with a log-rank test estimated survival. Factors associated with survival were assessed using Cox's proportional hazards model after adjustment for confounders.

Results: Patients with osteopenia had shorter overall (p = 0.0001; 5-year overall survival, 51.8% vs 81.8%) and recurrence-free survival (p = 0.0008, 5-year recurrence-free survival: 26.3% vs 51.5%) than BMD-normal patients. In multivariable analysis, the risk factor for overall survival was osteopenia (Hazard ratio (HR) 3.79, 95% confidence interval (CI) 2.09-6.87, p = 0.001). Risk factors for recurrence were chemotherapy (HR 1.92, 95%CI 1.12-3.30, p = 0.002), tumor number (HR 1.51, 95%CI 1.02-2.27, p = 0.04), and osteopenia (HR 2.18, 95%CI 1.46-3.24 p = 0.001). Patients with osteopenia are more likely to develop lung metastases, and BMD-value reduction associated with KRAS mutation.

Conclusion: Osteopenia may have prognostic significance in patients with liver metastases colorectal cancer.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Overall Survival in patients with or without osteopenia.
Fig 2
Fig 2. Recurrence-free survival in patients with or without osteopenia.
Fig 3
Fig 3. Box-plot of bone mineral density with or without KRAS mutation.
See this image and copyright information in PMC

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