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Visceral Adipose Tissue Changes After Surgery in Colorectal Cancer Patients May Have Prognostic Implications
Eun Kyung Choe*1,2, Heung-Kwon OH2, Sang Hui Moon2, Seung-Bum Ryoo2, Kyu Joo Park2
1Surgery, Seoul National University Hospital Healthcare System Gangnam Center, seoul, Republic of Korea; 2Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
Purpose> Although studies suggested the possible relationship between the amount of visceral adipose tissue and prognosis in colorectal cancer (CRC) patients, there are few studies assessing the changes in body component after colectomy. We intended to verify the adipose tissue area changes before and after surgery to determine their clinical relevance.
Methods> CT assessed adipose tissue areas (subcutaneous, SAT; visceral, VAT) were measured before and annually after curative resection in stage I to III CRC patients. Patients who had total colectomy or stoma were excluded. Demographic and clinical characteristics were reviewed in prospectively collected cohort of patients. Changes in adipose tissue area were assessed by calculating the difference of adipose tissue area between preoperative and most recent postoperative CT without any findings of recurrence. Adipose tissue obesity was defined as amount of more than 50 percentiles.
Results> The study cohort included 447 males and 254 females (age 62.0±10.8 years). Median follow up period was 67.3+/-17.8months (range:12.3-102.2months). CT scans were available in 651 patients (CT follow up duration : median 44.6months, range 12.3-82.8months). Preoperative VAT obesity was observed in 323 patients (49.4%) and SAT obesity in 266 (47%). Preoperative VAT obesity was associated with earlier TNM stage (p=0.042) and negative venous invasion (p=0.02). After surgery, 266 patients (53%) showed increase in VAT, and 358 patients (63.3%) in SAT after surgery. Chemotherapy did not influence in VAT or SAT changes (p=0.086). Increase in VAT amount after surgery was associated with pathologic differentiation and increase in SAT with T stage and TNM stage. By Kaplan Meier analysis, increased VAT and SAT after surgery showed higher OS (p=0.001, 0.03) and DFS (p=0.004, 0.02) in stage 3. On univariate analysis, TNM stage, pathologic differentiation, perineural invasion, preoperative CEA level, postoperative VAT and SAT change were significant predictors of OS and DFS. Preoperative VAT obesity was not associated with OS (p=0.148) and DFS (p=0.615). By multivariate Cox regression analysis, TNM stage (p=0.049), differentiation (p=0.006), perineural invasion (p=0.000) and postoperative VAT change (HR, decrease : increase = 1 : 0.493, p=0.012) were significant predictors for OS and DFS.
Conclusions> In contrary to other studies, preoperative visceral obesity was not a predictor for poor prognosis in our cohort of patients. Instead, the increase in visceral fat amount after surgery was a significant positive predictor of overall and disease free survival in CRC patients undergoing curative resection.
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