Cancer Res Treat.  2020 Jul;52(3):957-972. 10.4143/crt.2019.695.

Computed Tomography–Determined Sarcopenia Is a Useful Imaging Biomarker for Predicting Postoperative Outcomes in Elderly Colorectal Cancer Patients

• Xie H
• Gong Y
• Kuang J
• Yan L
• Ruan G
• Tang S
• Gao F
• Gan J

• KMID: 2504474
• DOI: http://doi.org/10.4143/crt.2019.695

Abstract

Purpose
This study aimed to establish whether computed tomography (CT)–determined sarcopenia is a useful imaging biomarker for postoperative outcome in elderly colorectal cancer (CRC) patients, and construct sarcopenia-based nomograms to predict individual outcomes after surgery.
Materials and Methods
CT imaging data of 298 elderly CRC patients who underwent surgery in 2012-2014 were retrospectively analyzed. Skeletal muscle mass was determined by CT, and sarcopenia was diagnosed based on the optimal cutoff value determined by X-tile program. The correlation between sarcopenia and risk of preoperative nutrition and postoperative complications was evaluated. A Cox proportional hazards model was used to determine survival predictors. Sarcopenia-based nomograms were developed based on multivariate analysis, and calibrated using concordance index and calibration curves.
Results
A total 132 patients (44.3%) had sarcopenia based on the optimum cutoff values (29.9 cm2/m2 for women and 49.5 cm2/m2 for men). Sarcopenia was an independent risk factor for preoperative nutrition (p < 0.001; odds ratio [OR], 3.405; 95% confidence interval [CI], 1.948 to 5.954) and postoperative complications (p=0.008; OR, 2.192; 95% CI, 1.231 to 3.903). Sarcopenia was an independent predictor for poor progression-free survival (p < 0.001; hazard ratio [HR], 2.175; 95% CI, 1.489 to 3.179) and overall survival (p < 0.001; HR, 2.524; 95% CI, 1.721 to 3.703). Based on multivariate analysis, we produced four nomograms that had better predictive performance.
Conclusion
CT-determined sarcopenia is a useful imaging biomarker for predicting preoperative nutritional risk, postoperative complications, and long-term outcomes in elderly CRC patients. The sarcopenia-based nomograms can provide a scientific basis for guiding therapeutic schedule and follow-up strategies.

Keyword

Elderly colorectal cancer; CT-determined sarcopenia; Prognosis; Nutrition; Complication

Figure

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  Fig. 1. The process of patients’ inclusion and exclusion in elderly colorectal cancer patients.

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  Fig. 2. Kaplan-Meier survival curves of sarcopenia and non-sarcopenia groups of all elderly colorectal cancer patients. (A) Kaplan-Meier progression-free survival (PFS) curves of all patients. (B) Kaplan-Meier overall survival (OS) curves of all patients.

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  Fig. 3. Kaplan-Meier survival curves of sarcopenia and non-sarcopenia groups of elderly colorectal cancer patients based on each TNM stage. (A) Kaplan-Meier progression-free survival (PFS) curves of TNM I stage patients. (B) Kaplan-Meier PFS curves of TNM II stage patients. (C) Kaplan-Meier PFS curves of TNM III stage patients. (D) Kaplan-Meier overall survival (OS) curves of TNM I stage patients. (E) Kaplan-Meier OS curves of TNM II stage patients. (F) Kaplan-Meier OS curves of TNM III stage patients.

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  Fig. 4. Subgroup multivariate survival analysis of sarcopenia in elderly colorectal cancer patients. (A) Subgroup multivariate progression-free survival (PFS) analysis of sarcopenia. (B) Subgroup multivariate overall survival (OS) analysis of sarcopenia. HR, hazard ratio; CI, confidence interval; ALB, albumin; BMI, body mass index; ASA, American Society of Anesthesiologists; CEA, carcinoembryonic antigen.

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  Fig. 5. Construction of sarcopenia-based nomograms in elderly colorectal cancer patients. (A) Sarcopenia-based nomograms of nutritional risk. (B) Sarcopenia-based nomograms of complication risk. (C) Sarcopenia-based nomograms of progression-free survival (PFS) (D) Sarcopenia-based nomograms of overall survival (OS). BMI, body mass index.

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  Fig. 6. The calibration curves for predicting nutritional risk (A), complication risk (B), progression-free survival (PFS) (C), and overall survival (OS) (D) in elderly colorectal cancer patients. The X axis presents the predicted probability and the Y axis shows the actual probability. The calibration lines fit along with the 45 reference.

Reference

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