Assessment of Computed Tomography (CT)-Defined Muscle and Adipose Tissue Features in Relation to Short-Term Outcomes After Elective Surgery for Colorectal Cancer: A Multicenter Approach
Sarcopenia, visceral obesity (VO), and reduced muscle radiodensity (myosteatosis) are suggested risk factors for postoperative morbidity in colorectal cancer (CRC), but usually are not concurrently assessed. Published thresholds used to define these features are not CRC-specific and are defined in relation to mortality, not postoperative outcomes. This study aimed to evaluate body composition in relation to length of hospital stay (LOS) and postoperative outcomes.
Pre-surgical computed tomography (CT) images were assessed for total area and radiodensity of skeletal muscle and visceral adipose tissue in a pooled Canadian and UK cohort (n = 2100). Sex- and age-specific values for these features were calculated. For 1139 of 2100 patients, LOS data were available, and sex- and age-specific thresholds for sarcopenia, myosteatosis, and VO were defined on the basis of LOS. Association of CT-defined features with LOS and readmissions was explored using negative binomial and logistic regression models, respectively.
In the multivariable analysis, the predictors of LOS (P < 0.001) were age, surgical approach, major complications (incidence rate ratio [IRR] 2.42; 95% confidence interval [CI] 2.18–2.68), study cohort, and three body composition profiles characterized by myosteatosis combined with either sarcopenia (IRR, 1.27; 95% CI 1.12–1.43) or VO (IRR, 1.25; 95% CI 1.10–1.42), and myosteatosis combined with both sarcopenia and VO (IRR, 1.58; 95% CI 1.29–1.93). In the multivariable analysis, risk of readmission was associated with VO alone (odds ratio [OR] 2.66; 95% CI 1.18–6.00); P = 0.018), VO combined with myosteatosis (OR, 2.72; 95% CI 1.36–5.46; P = 0.005), or VO combined with myosteatosis and sarcopenia (OR, 2.98; 95% CI 1.06–5.46; P = 0.038). Importantly, the effect of body composition profiles on LOS and readmission was independent of major complications.
The findings showed that CT-defined multidimensional body habitus is independently associated with LOS and hospital readmission.
Funding for Lisa Martin was provided by the Izaak Walton Killam Memorial Scholarship, an Alberta Innovates Health Solutions Graduate Research Studentship, and a C. Richard Fleming Grant from the ASPEN Rhoads Research Foundation. Project funding was provided by the Alberta Innovates Health Solutions Partnership for Research and Innovation in the Health System Grant and Alberta Health Services Cancer Strategic Clinical Network.
- 29.van der Kroft G, Bours D, Janssen-Heijnen DM, van Berlo D, Konsten D. Value of sarcopenia assessed by computed tomography for the prediction of postoperative morbidity following oncological colorectal resection: a comparison with the malnutrition screening tool. Clin Nutr. 2018;24:114–9.Google Scholar
- 32.Baracos VE. Psoas as a sentinel muscle for sarcopenia: a flawed premise. J Cachexia Sarcopenia Muscle. 2017;8:527–8.Google Scholar
- 40.Rolland Y, Czerwinski S Fau-Abellan Van Kan G, Abellan Van Kan G Fau-Morley JE, et al. Sarcopenia: its assessment, etiology, pathogenesis, consequences and future perspectives. J Nutr Health Aging. 2008;12:433–50.Google Scholar
- 49.van der Werf A, Dekker IM, Meijerink MR, Wierdsma NJ, de van der Schueren MAE, Langius JAE. Skeletal muscle analyses: agreement between non-contrast and contrast CT scan measurements of skeletal muscle area and mean muscle attenuation. Clin Physiol Funct Imaging. 2017;38:366–72.CrossRefPubMedGoogle Scholar
- 50.van Vugt JLA, Coebergh van den Braak RRJ, Schippers HJW, et al. Contrast-enhancement influences skeletal muscle density, but not skeletal muscle mass, measurements on computed tomography. Clin Nutr. 2017. https://doi.org/10.1016/j.clnu.2017.07.007.
- 51.Weaver BW, Wuensch K.L. SPSS and SAS programs for comparing Pearson correlations and OLS regression coefficients. Behav Res Methods. 2013;45:880–95.Google Scholar
- 54.Xiao J, Caan BJ, Weltzien E, et al. Associations of preexisting comorbidities with skeletal muscle mass and radiodensity in patients with non-metastatic colorectal cancer. J Cachexia Sarcopenia Muscle. 2018 https://doi.org/10.1002/jcsm.12301. Retrieved online 19 April 2018.