Prognostic effect of sarcopenia in colorectal cancer recurrence

Koichi Takiguchi; Shinji Furuya; Makoto Sudo; Ryo Saito; Atsushi Yamamoto; Naoki Ashizawa; Kazuyoshi Hirayama; Katsutoshi Shoda; Hidenori Akaike; Naohiro Hosomura; Yoshihiko Kawaguchi; Hidetake Amemiya; Hiromichi Kawaida; Shingo Inoue; Hiroshi Kono; Daisuke Ichikawa

doi:10.1016/j.nut.2021.111362

Prognostic effect of sarcopenia in colorectal cancer recurrence

Nutrition. 2021 Nov-Dec:91-92:111362. doi: 10.1016/j.nut.2021.111362. Epub 2021 Jun 2.

Authors

Koichi Takiguchi¹, Shinji Furuya², Makoto Sudo¹, Ryo Saito¹, Atsushi Yamamoto¹, Naoki Ashizawa¹, Kazuyoshi Hirayama¹, Katsutoshi Shoda¹, Hidenori Akaike¹, Naohiro Hosomura¹, Yoshihiko Kawaguchi¹, Hidetake Amemiya¹, Hiromichi Kawaida¹, Shingo Inoue¹, Hiroshi Kono¹, Daisuke Ichikawa¹

Affiliations

¹ First Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
² First Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan. Electronic address: sfuruya@yamanashi.ac.jp.

PMID: 34274653
DOI: 10.1016/j.nut.2021.111362

Abstract

Objectives: Nutritional status significantly influences postoperative prognosis in gastrointestinal cancers. It has been evaluated using sarcopenia before treatments such as surgery and chemotherapy, despite constant changes in nutritional status. We consider that nutritional status at cancer recurrence is one of the important factors that affect treatment choice and intensity. This study evaluated the prognostic effects of improved postoperative nutritional status for people with colorectal cancer recurrence.

Methods: We enrolled 209 participants with pathologically confirmed stage II or III colorectal cancer who underwent radical resection. Sarcopenia was diagnosed using the psoas muscle index obtained from analysis of three-dimensional computed tomographic images. We adopted the cutoff value that was proposed by Hamaguchi et al. (psoas muscle index < 6.36 cm²/m² for men and < 3.92 cm²/m² for women). Evaluation was performed before surgery and at the time of recurrence. Participants with preoperative sarcopenia who relapsed were divided into two groups at the time of recurrence: sarcopenia continuation and sarcopenia improvement. We compared the prognosis of the two groups and examined the effect of postoperative nutritional improvement.

Results: Among the 209 participants, 81 (38.8%) had preoperative sarcopenia; this group had significantly lower overall survival than those without sarcopenia (P = 0.028). Colorectal cancer recurred in 48 participants. Of those 46, sarcopenia was evaluated at the time of recurrence; 19 of those 46 had preoperative sarcopenia. Preoperative sarcopenia did not affect the cancer recurrence ratio (sarcopenia, 23.5%; non-sarcopenia, 21.3%; P = 0.893). The sarcopenia-improvement group had higher overall survival than the sarcopenia-continuation group (P = 0.042).

Conclusions: Among participants with preoperative sarcopenia, the prognosis at the time of recurrence improved for the sarcopenia-improvement group compared to the sarcopenia-continuation group. In people with colorectal cancer and sarcopenia, nutritional management is important not only before but also after surgery.

Keywords: Gastrointestinal tumors; Nutritional status; Postoperative nutritional intervention; Psoas muscle index; Sarcopenia improvement.

MeSH terms

Colorectal Neoplasms* / complications
Female
Humans
Male
Postoperative Complications / pathology
Prognosis
Psoas Muscles / pathology
Retrospective Studies
Sarcopenia* / pathology