Cancer Res Treat.  2020 Apr;52(2):563-572. 10.4143/crt.2019.249.

Association of Body Composition with Long-Term Survival inNon-metastatic Rectal Cancer Patients

• Han JS
• Ryu H
• Park IJ
• Kim KW
• Shin Y
• Kim SO
• Lim SB
• Kim CW
• Yoon YS
• Lee JL
• Yu CS
• Kim JC

• KMID: 2500341
• DOI: http://doi.org/10.4143/crt.2019.249

Abstract

Purpose
We evaluated the association of body composition with long-term oncologic outcomes in non-metastatic rectal cancer patients.
Materials and Methods
We included 1,384 patients with stage(y)0-III rectal cancer treated at Asan Medical Center between January 2005 and December 2012. Body composition at diagnosis was measured using abdomino-pelvic computed tomography (CT). Sarcopenia, visceral obesity (VO), and sarcopenic obesity (SO) were defined using CT measured parameters such as skeletal muscle index (total abdominal muscle area, TAMA), visceral fat area (VFA), and VFA/TAMA. Inflammatory status was defined as a neutrophil-lymphocyte ratio of ! 3. Obesity was categorized by body mass index (! 25 kg/m2).
Results
Among the 1,384 patients, 944 (68.2%) had sarcopenia and 307 (22.2%) had SO. The 5-year overall survival (OS) rate was significantly lower in sarcopenic patients (no sarcopenia vs. sarcopenia; 84% vs. 78%, p=0.003) but the 5-year recurrence-free survival (RFS) rate was not different (77.3% vs. 77.9% p=0.957). Patients with SO showed lower 5-year OS (79.1% vs. 75.5% p=0.02) but no difference in 5-year RFS (p=0.957). Sarcopenia, SO, VO, and obesity were not associated with RFS. However, obesity, SO, age, sex, inflammatory status, and tumor stage were confirmed as independent factors associated with OS on multivariate analysis. In subgroup analysis, association of SO with OS was more prominent in patients with (y)p stage 0-2 and no inflammatory status.
Conclusion
The presence of SO and a low body mass index at diagnosis are negatively associated with OS in non-metastatic rectal cancer patients.

Keyword

Rectal neoplasms; Sarcopenia; Obesity; Overall survival; Recurrence-free survival

Figure

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  Fig. 1. Body morphometric evaluations of abdominal fat and muscle areas. At the level of the inferior endplate of the L3 vertebra, an axial computed tomography image was segmented into the total abdominal muscle area (TAMA), visceral fat area (VFA), and subcutaneous fat area (SFA).

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  Fig. 2. (A-C) Correlation among skeletal muscle index (SMI) and body mass index (BMI), and visceral fat area (VFA). (A) The SMI and BMI showed a positive correlation (r=0.637).

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  Fig. 3. Overall survival (OS) outcomes according to sarcopenia (A), sarcopenic obesity (SO) (B), and the neutrophil-lymphocyte ratio (NLR) (C). Sarcopenia and SO showed negative association with the 5-year overall survival rate. A high NLR was also associated with a poorer 5-year OS.

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  Fig. 4. Association between overall survival (OS) and sarcopenia and sarcopenic obesity (SO) according to the pathologic stage of the rectal tumor. The influence of sarcopenia on survival was evaluated in patients with (y)p stage 0-2 (A) and (y)p stage 3 (B) tumor. The association between SO and OS was also evaluated in the (y)p stage 0-2 (C) and (y)p stage 3 (D) rectal cancer cases. LNM, lymph node metastasis.

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  Fig. 5. Association between overall survival (OS) and sarcopenia and sarcopenic obesity (SO) according to the inflammatory status of the rectal cancer patients. The influence of sarcopenia on the OS rate in patients with a non-inflammatory (A) and inflammatory (B) status was assessed. The association between SO and OS outcomes in non-inflammatory (C) and inflammatory (D) status cases was also evaluated.

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