CLINICAL IMPACT OF MUSCLE QUANTITY AND QUALITY IN COLORECTAL CANCER PATIENTS: A PROPENSITY SCORE MATCHING ANALYSIS
Yukina Kusunoki*, Yuji Toiyama, Yoshinaga Okugawa, Akira Yamamoto, Kurando Kusunoki, Yusuke Omura, Chengzeng Yin, Shozo Ide, Takahito Kitajima, Hiroyuki Fujikawa, Hiromi Yasuda, Junichiro Hiro, Shigeyuki Yoshiyama, Masaki Ohi, Toshimitsu Araki, Masato Kusunoki
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
Background. Sarcopenia is defined as the loss of skeletal muscle mass accompanied by decreased muscle strength which consists of myopenia and myosteatosis. Myopenia is known as a decreased skeletal muscle mass irrespective of illness and aging, and myosteatosis is characterized by increased infiltration by inter- and intramuscular fat. Recent evidence has suggested the predictive value of sarcopenia for the risk of perioperative and oncological outcomes in various malignancies. In colorectal cancer (CRC) patients, the clinical feasibility of preoperative sarcopenia as a predictive marker for operative and oncological risk has remained controversial. Furthermore, the prognostic impact of sarcopenia using propensity score matching analysis has never been evaluated. In this study, we systemically and comprehensively investigated the short-term and long-term impact of sarcopenia, and also turned our attention to the clinical significance and predictive value of preoperative myopenia using propensity score matching analysis in CRC patients.
Method. We conducted a retrospective study of CRC patients who underwent surgery at our institution from 2005 to 2011. Cross-sectional area of the psoas muscles at the L4 vertebral level were measured using preoperative computed tomography(CT), and then psoas muscle mass index (PMI) was calculated. CT values (in Hounsfield units) of the subfascial muscular tissue in the multifidus muscle and the subcutaneous fat at the same level were also measured to calculate intramuscular adipose tissue content (IMAC). Adjusted logistic regression and survival analysis was performed to analyze outcomes.
Results. In this study, 308 patients with CRC were included. Despite no significant correlation between myosteatosis and prognosis, preoperative myopenia significantly correlated with clinicopathological factors for disease development, including advanced T stage (P=0.009), presence of lymphatic vessel invasion (P=0.006), distant metastasis (P=0.0007), and advanced stage classification (P=0.013). Presence of preoperative myopenia was an independent prognostic factor for both cancer-specific survival (CSS: HR:2.75, 95% CI:1.5-5.05, p=0.001) and disease-free survival (DFS: HR:3.15, 95% CI:1.8-5.51, p=0.0001), and was an independent risk factor for postoperative infectious complications (PIC) in CRC patients (OR:2.03, 95% CI:1.17-3.55, p=0.013). Furthermore, all of these findings were successfully validated using propensity score matching analysis (CSS:HR:2.38, 95%CI:1.05-5.44, P=0.039; DFS:HR:3.15, 95%CI:1.48-6.71, P=0.003, PIC:OR:2.7, 95%CI:1.25-5.8, P=0.011).
Conclusion. Preoperative myopenia could be useful for perioperative management, and quantification of preoperative skeletal muscle mass could identify patients as a high risk for perioperative and oncological outcomes in CRC patients.
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