Sex differences in the association of triceps skinfold thickness and colorectal cancer mortality

Abstract

Objectives: Triceps skinfold thickness (TSF) is an economical and effective anthropometric method for estimating cellulite. It has attracted increasing attention as a parameter to assess cancer prognosis. Owing to physiologic differences, the sex-specific value of TSF in the prognostic assessment of colorectal cancer (CRC) is unclear. The aim of this study was to explore the sex differences in the association of TSF and CRC mortality and provide practical clinical guidelines for optimizing prognostic strategies and nutritional guidance for patients with CRC.

Methods: Restricted cubic spline (RCS) regression was used to flexibly analyze the sex-specific relationship between continuous TSF and mortality. Cox regression analysis was used to estimate the independent association between TSF and mortality in CRC patients. Finally, the study population was randomly allocated to two validation cohorts for internal randomization validation.

Results: We found an L-shaped association between the TSF and survival of CRC patients. Multivariable-adjusted RCS showed that TSF was associated with non-significant reduced mortality in men (P = 0.076). However, in women, continuous TSF was significantly associated with reduced mortality (P = 0.002). Multivariable-adjusted Cox regression analyses confirmed that TSF was an independent factor affecting the prognosis of women with CRC (hazard ratio [HR], 0.834; 95% confidence interval [CI], 0.748-0.930; log-rank P = 0.001), but not men with CRC (HR, 0.943; 95% CI, 0.869-1.024; log-rank P = 0.161). TSF was also an independent factor for predicting life function, cachexia, and malnutrition in patients with CRC. The randomization internal validation also showed a stronger association between TSF and all-cause mortality in women than in men.

Conclusions: TSF is an independent factor affecting the prognosis of women with CRC; however, the prognostic value of TSF in men with CRC may be limited.

Keywords: Adipose tissue; Colorectal cancer; Sex; Triceps skinfold thickness.