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Quantitative assessment of mesorectal fat: new prognostic biomarker in patients with mid-to-lower rectal cancer

  • Oncology
  • Published:
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Abstract

Objectives

To investigate the impact of mesorectal fat area (MFA) on oncologic outcomes in patients with mid-to-lower rectal cancer who received curative-intent surgery.

Methods

Patients with mid-to-lower rectal cancer who underwent preoperative abdominopelvic computed tomography (CT) and curative-intent surgery in 2011 were divided into two groups by tumour recurrence (group A) or no recurrence (group B) during a 5-year follow-up. Visceral fat area (VFA) and MFA were measured on preoperative CT and cutoff values were calculated using the Youden index. Univariate and multivariate regression analyses including BMI, VFA, and MFA were performed to investigate meaningful prognostic biomarkers. The Kaplan–Meier method with log-rank testing was used to validate prognostic biomarkers.

Results

Group A contained 42 patients and group B had 155 patients. Cutoff values were 25 kg/m2 for BMI, 130 cm2 for VFA, and 10 cm2 for MFA using the Youden index. On multivariate Cox regression analysis, MFA (odds ratio [OR] = 0.426, p = 0.010), TNM stage (p = 0.027), and perioperative complication grade (p = 0.028) were significantly different between groups. BMI and VFA did not show significant differences. By the Kaplan–Meier method with log-rank testing, disease-free survival (DFS) was significantly longer in patients with MFA ≥10 cm2 compared to patients with MFA <10 cm2 (p = 0.021), with no significant difference in overall survival (OS).

Conclusions

MFA was an independent biomarker for predicting DFS in patients who underwent curative-intent surgery for mid-to-lower rectal cancer.

Key Points

• Mesorectal fat area is associated with the prognosis of rectal cancer patients.

• Mesorectal fat area can be calculated easily in pre-operative CT scan.

• Predicting prognosis of the cancer patient before operation is important.

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Abbreviations

APR:

Abdominoperineal resection

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

CCRTx:

Chemoradiation therapy

CEA:

Carcinoembryonic antigen

DFS:

Disease free survival

HU:

Hounsfield units

ISD:

Interspinous distance

LAR:

Low anterior resection

LN:

Lymph node

MFA:

Mesorectal fat area

OS:

Overall survival

SD:

Standard deviation

TC:

True conjugate

TME:

Total mesorectal excision

ULAR:

Ultralow anterior resection

VFA:

Visceral fat area

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Jiyoung Yoon, Yong Eun Chung, Joon Seok Lim & Myeong-Jin Kim

  2. BK21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea

    Yong Eun Chung

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  1. Jiyoung Yoon
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  2. Yong Eun Chung
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Corresponding author

Correspondence to Yong Eun Chung.

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Guarantor

The scientific guarantor of this publication is Dr. Myeong-Jin Kim, Severance Hospital.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Yunho Rho, Yonsei University, College of Medicine, kindly provided statistical advice for this manuscript.

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Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Yoon, J., Chung, Y.E., Lim, J.S. et al. Quantitative assessment of mesorectal fat: new prognostic biomarker in patients with mid-to-lower rectal cancer. Eur Radiol 29, 1240–1247 (2019). https://doi.org/10.1007/s00330-018-5723-5

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  • DOI: https://doi.org/10.1007/s00330-018-5723-5

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