Skip to main content

Advertisement

SpringerLink
Log in

Sarcopenia is a Negative Prognostic Factor After Curative Resection of Colorectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Skeletal muscle depletion (sarcopenia) is closely associated with limited physical ability and high mortality. This study was performed to evaluate the prognostic significance of skeletal muscle depletion in patients with resectable stage I–III colorectal cancer (CRC).

Methods

We conducted a retrospective analysis of 220 consecutive patients with stage I–III CRC who underwent curative resection. The skeletal muscle cross-sectional area was measured by preoperative computed tomography. The lowest sex-specific quartile of skeletal muscle mass was classified as sarcopenia. Factors contributing to recurrence-free survival (RFS) were analyzed by univariate and multivariate Cox proportional hazard models.

Results

Of 220 patients who met our inclusion criteria, 55 (25 %) had sarcopenia. The median follow-up duration was 41.4 months. Patients with sarcopenia were younger and had higher carcinoembryonic antigen levels than patients without sarcopenia. RFS and overall survival (OS) were significantly shorter in patients with sarcopenia than those without (5-year RFS, 56 vs. 79 %, log-rank p = 0.006; 5-year OS, 68 vs. 85 %, log-rank p = 0.015). Multivariate Cox regression analysis revealed that sarcopenia was independently associated with shorter RFS (hazard ratio [HR] 2.176; 95 % confidence interval [CI] 1.200–3.943; p = 0.010) and OS (HR 2.270; 95 % CI 1.147–4.494; p = 0.019). The influence of sarcopenia on patient outcome was modified by age at surgery (p value for interaction = 0.026); sarcopenia was associated with a poor prognosis, especially in young patients (log-rank p < 0.001).

Conclusions

Sarcopenia negatively impacts survival in patients undergoing curative resection for stage I–III CRC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Fearon K, Arends J, Baracos V. Understanding the mechanisms and treatment options in cancer cachexia. Nat Rev Clin Oncol. 2013;10:90-99.

    Article  CAS  PubMed  Google Scholar 

  2. Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12:489-495.

    Article  PubMed  Google Scholar 

  3. Evans WJ. Skeletal muscle loss: cachexia, sarcopenia, and inactivity. Am J Clin Nutr. 2010;91:1123S-1127S.

    Article  CAS  PubMed  Google Scholar 

  4. Muscaritoli M, Anker SD, Argiles J, et al. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr. 2010;29:154-159.

    Article  CAS  PubMed  Google Scholar 

  5. van Vledder MG, Levolger S, Ayez N, et al. Body composition and outcome in patients undergoing resection of colorectal liver metastases. Br J Surg. 2012;99:550-557.

    Article  PubMed  Google Scholar 

  6. Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9:629-635.

    Article  PubMed  Google Scholar 

  7. Iritani S, Imai K, Takai K, et al. Skeletal muscle depletion is an independent prognostic factor for hepatocellular carcinoma. J Gastroenterol. doi:10.1007/s00535-014-0964-92014.

  8. Voron T, Tselikas L, Pietrasz D, et al. Sarcopenia impacts on short- and long-term results of hepatectomy for hepatocellular carcinoma. Ann Surg. doi:10.1097/SLA.0000000000000743.

  9. Sabel MS, Lee J, Cai S, et al. Sarcopenia as a prognostic factor among patients with stage III melanoma. Ann Surg Oncol. 2011;18:3579-3585.

    Article  PubMed  Google Scholar 

  10. Tan BH, Birdsell LA, Martin L, et al. Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. Clin Cancer Res. 2009;15:6973-6979.

    Article  CAS  PubMed  Google Scholar 

  11. Lieffers JR, Bathe OF, Fassbender K, et al. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer. 2012;107:931-936.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Hasselager R, Gögenur I. Core muscle size assessed by perioperative abdominal CT scan is related to mortality, postoperative complications, and hospitalization after major abdominal surgery: a systematic review. Langenbecks Arch Surg. 2014;399:287-295.

    Article  PubMed  Google Scholar 

  13. Baumgartner RN, Koehler KM, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998;147:755-763.

    Article  CAS  PubMed  Google Scholar 

  14. Dodson S, Baracos VE, Jatoi A, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment strategies. Annu Rev Med. 2011;62:265-279.

    Article  CAS  PubMed  Google Scholar 

  15. Richards CH, Roxburgh CS, MacMillan MT, et al. The relationships between body composition and the systemic inflammatory response in patients with primary operable colorectal cancer. PLoS One. 2012;7:e41883.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Richards CH, Leitch EF, Horgan PG, et al. The relationship between patient physiology, the systemic inflammatory response and survival in patients undergoing curative resection of colorectal cancer. Br J Cancer. 2010;103:1356-1361.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Roxburgh CS, Platt JJ, Leitch EF, et al. Relationship between preoperative comorbidity, systemic inflammatory response, and survival in patients undergoing curative resection for colorectal cancer. Ann Surg Oncol. 2011;18:997-1005.

    Article  CAS  PubMed  Google Scholar 

  18. McMillan DC, Canna K, McArdle CS. Systemic inflammatory response predicts survival following curative resection of colorectal cancer. Br J Surg. 2003;90:215-219.

    Article  CAS  PubMed  Google Scholar 

  19. Aleman MR, Santolaria F, Batista N, et al. Leptin role in advanced lung cancer. A mediator of the acute phase response or a marker of the status of nutrition? Cytokine. 2002;19:21-26.

    Article  CAS  PubMed  Google Scholar 

  20. Mitsiopoulos N, Baumgartner RN, Heymsfield SB, et al. Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol (1985). 1998;85:115-122.

    Google Scholar 

Download references

Disclosure

Yuji Miyamoto, Yoshifumi Baba, Yasuo Sakamoto, Mayuko Ohuchi, Ryuma Tokunaga, Junji Kurashige, Yukiharu Hiyoshi, Shiro Iwagami, Naoya Yoshida, Megumi Yoshida, Masayuki Watanabe, and Hideo Baba declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Yuji Miyamoto MD, PhD, Yoshifumi Baba MD, PhD, Yasuo Sakamoto MD, PhD, Mayuko Ohuchi MD, Ryuma Tokunaga MD, Junji Kurashige MD, PhD, Yukiharu Hiyoshi MD, PhD, Shiro Iwagami MD, PhD, Naoya Yoshida MD, PhD, Megumi Yoshida & Hideo Baba MD, PhD

  2. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Masayuki Watanabe MD, PhD

Authors
  1. Yuji Miyamoto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshifumi Baba MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasuo Sakamoto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mayuko Ohuchi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryuma Tokunaga MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Junji Kurashige MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yukiharu Hiyoshi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shiro Iwagami MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Naoya Yoshida MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Megumi Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Masayuki Watanabe MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hideo Baba MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hideo Baba MD, PhD.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miyamoto, Y., Baba, Y., Sakamoto, Y. et al. Sarcopenia is a Negative Prognostic Factor After Curative Resection of Colorectal Cancer. Ann Surg Oncol 22, 2663–2668 (2015). https://doi.org/10.1245/s10434-014-4281-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-4281-6

Keywords

Search

Navigation