Effect Of CT-Determined Pre-therapeutic Sarcopenia On The Prognosis Of Patients With Colorectal Cancer

Objective:The aim of this study was to investigate the effect of CT-determined pre-therapeutic sarcopenia on the prognosis of patients with colorectal cancer,so as to guide the treatment by risk stratification to improve the prognosis of patients with colorectal cancer.Methods:This study collected the clinical,pathological and CT images of colorectal cancer patients who were first diagnosed in Yunnan Province Cancer Hospital from January 1,2013 to December 31,2017,and survival information of the patients was obtained through follow-up.Using Image J to measured muscle cross-sectional area on the CT images of third lumbar(L3)level,based on the definition of sarcopenia,patients can be divided into the sarcopenia group and the non-sarcopenia group,and the comparative analysis of two groups of patients with clinical and pathological characteristics could be analyzed.Then,use the Kaplan-Meier method and multivariable Cox proportional hazard models for survival analysis to investigate the effect of CT-determined pre-therapeutic sarcopenia on the prognosis of colorectal cancer patients.Results:1.Basic informationA total of 2999 patients with colorectal cancer were included in this study,including 1768 males(59.0%)and 1231 females(41.0%).The mean age of the patients was 58.78±12.22 years.The most common KPS score was 90(68.2%).There were 2558 patients(85.3%)with CCI≤5,which was much more than those with CCI≥6.There were 722 smoking patients(24.1%).Most of the primary tumors were located in the left colon(87.5%).The most common symptoms were hematochezia(69.9%),abdominal pain(33.5%)and defecation difficulties(17.0%).The most common degree of pathologic differentiation was middle differentiation(42.1%),and the most rare was high differentiation(1.0%).Stage Ⅲ(38.9%)patients accounted for the largest proportion of TNM stage,followed by stage Ⅱ(29.1%),stage Ⅳ(18.8%)and stage Ⅰ(13.2%).The most common site of metastasis was liver metastasis(11.9%).A total of 1731 patients(57.72%)were diagnosed with visceral obesity.2.Comparison of clinicopathological characteristics between the sarcopenia group and the non-sarcopenia groupOf the 2999 patients,a total of 466 patients were diagnosed with sarcopenia,with an incidence of 15.54%,including 411 males with an incidence of 23.25%(411/1768))and 55 females with an incidence of 4.47%(55/1231)).Compared with the non-sarcopenia group,the proportion of male,the proportion of visceral obesity and the proportion of smoking were higher in the sarcopenia group(all P<0.05),and there was no statistical significance in other clinicopathological characteristics between the two groups(P>0.05).3 Survival analysis results3.1 Basic survival conditionsThe overall 1-year,3-year and 5-year cumulative survival rates were 88,9%,73.4%and 65%,respectively.The mean survival time was 47.28±25.76 months,and the median survival time was not reached in this study.3.2 Univariate survival analysisSingle factor Kaplan-Meier method analysis results showed that age,gender,KPS score,CCI,degree of pathological differentiation,TNM stage,chemotherapy,surgery,targeted therapy,radiotherapy,visceral obesity and sarcopenia are factors influence the prognosis of colorectal cancer(all P<0.05).3.3 Multivariate survival analysisMultivariate Cox regression results showed that age,degree of pathological differentiation,TNM stage,CCI,chemotherapy,surgery and sarcopenia were all prognostic factors for colorectal cancer(all P<0.05),and sarcopenia was an independent risk factor for prognosis of colorectal cancer(P=0.001,HR=1.322,95%CI=1.115～1.567).Conclusion:Combined with CT-determined pre-therapeutic sarcopenia can shorten the survival time of patients with colorectal cancer,and pre-therapeutic sarcopenia is an independent risk factor affecting the prognosis of patients with colorectal cancer.Early screening for sarcopenia in colorectal cancer patients will be beneficial to guide appropriate and reasonable sarcopenia intervention treatment,so as to improve the prognosis of patients with colorectal cancer.