SSAT - SARCOPENIA IN EARLY-ONSET COLORECTAL CANCER: A NEW AND PROMISING APPROACH

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SARCOPENIA IN EARLY-ONSET COLORECTAL CANCER: A NEW AND PROMISING APPROACH
C�sar Bars�n P�rez Izquierdo¹, Luz Divina Juez¹, Juan Carlos Garc�a P�rez¹, Araceli Ballestero P�rez¹, Juan Oca�a¹, Jose A. Rueda⁴, Lorena Brand�riz², Sergio Hern�ndez-Villafranca⁵, Riccardo Levi^6,3, Alessandra Caracciolo^6,3, Cristiana Bonifacio^6,3, Caterina Foppa^6,3, Javier Die Trill¹, Jos� Mar�a Fern�ndez Cebri�n¹, Javier Bl�zquez¹, Antonino Spinelli^6,3, Jose Perea^*^2,7
¹GENERAL AND DIGESTIVE SURGERY DEPARTMENT, Hospital Universitario Ramon y Cajal, Madrid, Spain; ²Vithas Hospitales, Madrid, Madrid, Spain; ³IRCCS Humanitas Research Hospital, Rozzano, Lombardia, Italy; ⁴Hospital Universitario Fundacion Alcorcon, Alcorc�n, Community of Madrid, Spain; ⁵Hospital Universitario Fundacion Jimenez Diaz, Madrid, Community of Madrid, Spain; ⁶Department of Biomedical Sciences, Humanitas University, Milan, Italy, Milan, Italy; ⁷Molecular Medicine Unit-Department of Medicine, Institute of Biomedical Research of Salamanca (IBSAL) and Institute of Molecular and Cellular Biology of Cancer (IBMCC), University of Salamanca-SACYL-CSIC, Salamanca, Spain, Salamanca, Spain

Aim
Sarcopenia is the progressive loss of skeletal muscle mass. Traditionally, it has been associated with the geriatric populations. Recent studies suggest that young patients with colorectal cancer (CRC) are in a state of premature aging. The aim of this study was to assess the incidence of sarcopenia in Early-onset Colorectal Cancer (EOCRC) and evaluate its impact on oncological outcomes.

Method
An international multicenter study was performed from 5 different institutions enrolled in the Spanish EOCRC consortium and from the Humanitas Research Hospital in Italy from January 2018 to January 2024. A prospective study was designed analyzing a wide range of aspects of this CRC subtype. Skeletal muscle mass index (SMMI) cross-sectional area at the L3 vertebra was measured for all patients in the staging computed tomography. Sarcopenia was defined by a SMMI <38.5 cm2/m2 for females and <52.4 cm2/m2 for males. Other radiological body characteristics such as muscle quality (myosteatosis) or visceral fatty tissue area were analyzed.

Results
197 patients were analyzed. The mean age was 42.16�6.1 years with a predominance of males (55.3%). As for the type of CRC tumor, the majority were rectal tumors (64%), sporadic type (59.4%) and without metastasis at diagnosis (77.7%). The median SMMI for males was 47.19 cm2/m2 and for females 39.02 cm2/m2 (p<0.001). The prevalence of sarcopenia was 61.9% (males 73.6% and females 46.6%). A Kaplan-Meier survival analysis was performed to identify the factors involved in Overall Survival (OS) and Disease-Free Survival (DFS). Univariate analysis for OS showed that patients with more advanced stage tumors (p < 0.001), signet ring cells (p=0.007) and sarcopenia (p=0.063) had worse survival. Survival analysis showed that rectal tumors (p=0.047), signet ring cell tumors (p=0.049) and myosteatosis measured by computed tomography (p=0.007) had worse disease-free survival. Furthermore, multivariate analysis showed sarcopenia at diagnosis to be an independent factor for worse disease-free survival (HR 2.09; 95% CI [1.06-4.14]; p=0.033).

Conclusions
Patients with EOCRC had a remarkably high incidence of sarcopenia and the initial diagnosis of this condition was associated with worse oncological outcomes. Although further studies are needed, these findings could add another argument to the hypothesis of an advanced state of aging in these patients and may be linked with other associated factors, as overweight and metabolic syndrome.

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