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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2017

Open Access 01-08-2017 | Gastrointestinal Oncology

Prognostic Value of Computed Tomography: Measured Parameters of Body Composition in Primary Operable Gastrointestinal Cancers

Authors: Douglas Black, MBChB, MSc, MRCS, Craig Mackay, MBChB, MRCS, PhD, George Ramsay, MBChB, MRCS, PhD, Zaid Hamoodi, MBChB, Shayanthan Nanthakumaran, MBChB, FRCS, MD, Kenneth G. M. Park, MBChB, FRCS, MD, Malcolm A. Loudon, MBChB, FRCS, MD, Colin H. Richards, MBChB, FRCS, MD

Published in: Annals of Surgical Oncology | Issue 8/2017

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Abstract

Background

Previous reports suggest that body composition parameters can be used to predict outcomes for patients with gastrointestinal (GI) cancers. However, evidence for an association with long-term survival is conflicting, with much of the data derived from patients with advanced disease. This study examined the effect of body composition on survival in primary operable GI cancer.

Methods

Patients with resectable adenocarcinoma of the GI tract (esophagus, stomach, colon, rectum) between 2006 and 2014 were identified from a prospective database. Computed tomography (CT) scans were analyzed using a transverse section at L3 to calculate sex-specific body composition indices for skeletal muscle, visceral fat, and subcutaneous fat. Kaplan–Meier and log-rank analysis were used to compare unadjusted survival. Multivariate survival analyses were performed using a proportional hazards model.

Results

The study enrolled 447 patients (191 woman and 256 men) with esophagogastric (OG) (n = 108) and colorectal (CR) (n = 339) cancer. Body composition did not predict survival for the OG cancer patients. Among the CR cancer patients, survival was shorter for those with sarcopenia (p = 0.017) or low levels of subcutaneous fat (p = 0.005). Older age (p = 0.046) and neutrophilia (p = 0.013) were associated with sarcopenia in patients with CR. Tumor stage (p = 0.033), neutrophil count (p = 0.011), and hypoalbuminemia (p = 0.023) were associated with sarcopenia in OG cancer patients. In the multivariate analysis, no single measure of body composition was an independent predictor of reduced survival.

Conclusion

Sarcopenia and reduced subcutaneous adiposity are associated with reduced survival for patients with primary operable CR cancer. However, in this study, no parameter of body composition was an independent prognostic marker when considered with age, tumor stage, and systemic inflammation.
Literature
1.
Yip C, Dinkel C, Mahajan A, Siddique M, Cook GJR, Goh V. Imaging body composition in cancer patients: visceral obesity, sarcopenia and sarcopenic obesity may impact on clinical outcome. Insights Imaging. 2015;6:489–97.CrossRefPubMedPubMedCentral
2.
Malietzis G, Aziz O, Bagnall NM, Johns N, Fearon KC, Jenkins JT. The role of body composition evaluation by computerized tomography in determining colorectal cancer treatment outcomes: a systematic review. Eur J Surg Oncol. 2015;41:186–96.CrossRefPubMed
3.
Wagner D, DeMarco MM, Amini N, et al. Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery. World J Gastrointest Surg. 2016;8:27–40.CrossRefPubMedPubMedCentral
4.
Levolger S, van Vugt JLA, de Bruin RWF, et al. Systematic review of sarcopenia in patients operated on for gastrointestinal and hepatopancreatobiliary malignancies. Br J Surg. 2015;102:1448–58.CrossRefPubMed
5.
Veasey Rodrigues H, Baracos VE, Wheler JJ, et al. Body composition and survival in the early clinical trials setting. Eur J Cancer. 2013;49:3068–75.CrossRefPubMed
6.
Martin L, Birdsell L, Macdonald N, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31:1539–47.CrossRefPubMed
7.
van Vledder MG, Levolger S, Ayez N, Verhoef C, Tran TCK, Ijzermans JNM. Body composition and outcome in patients undergoing resection of colorectal liver metastases. Br J Surg. 2012;99:550–7.CrossRefPubMed
8.
Harada K, Baba Y, Ishimoto T, et al. Low visceral fat content is associated with poor prognosis in a database of 507 upper gastrointestinal cancers. Ann Surg Oncol. 2015;22:3946–53.CrossRefPubMed
9.
Balentine CJ, Enriquez J, Fisher W, et al. Intra-abdominal fat predicts survival in pancreatic cancer. J Gastrointest Surg. 2010;14:1832–7.CrossRefPubMed
10.
Moon HG, Ju YT, Jeong CY, et al. Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann Surg Oncol. 2008;15:1918–22.CrossRefPubMed
11.
Lee CS, Murphy DJ, McMahon C, et al. Visceral adiposity is a risk factor for poor prognosis in colorectal cancer patients receiving adjuvant chemotherapy. J Gastrointest Cancer. 2015;46:243–50.CrossRefPubMed
12.
Mourtzakis M, Prado CMM, Lieffers JR, et al. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33:997–1006.CrossRefPubMed
13.
Maltoni M, Caraceni A, Brunelli C, et al. Prognostic factors in advanced cancer patients: evidence-based clinical recommendations: a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol. 2005;23:6240–8.CrossRefPubMed
14.
Proctor MJ, Morrison DS, Talwar D, et al. An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow Inflammation Outcome Study. Br J Cancer. 2011;104:726–34.CrossRefPubMedPubMedCentral
15.
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;107:931–6.CrossRefPubMedPubMedCentral
16.
Reisinger KW, van Vugt JLA, Tegels JJW, et al. Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery. Ann Surg. 2015;261:345–52.CrossRefPubMed
17.
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;9:629–35.CrossRefPubMed
18.
Prado CMM, Baracos VE, McCargar LJ, et al. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res. 2007;13:3264–8.CrossRefPubMed
19.
Mir O, Coriat R, Blanchet B, et al. Sarcopenia predicts early dose-limiting toxicities and pharmacokinetics of sorafenib in patients with hepatocellular carcinoma. PLoS One. 2012;7:e37563.CrossRefPubMedPubMedCentral
20.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis. Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412–23.CrossRefPubMedPubMedCentral
21.
Jung H-W, Kim JW, Kim J-Y, et al. Effect of muscle mass on toxicity and survival in patients with colon cancer undergoing adjuvant chemotherapy. Support Care Cancer. 2015;23:687–94.CrossRefPubMed
22.
Fujiwara N, Nakagawa H, Kudo Y, et al. Sarcopenia, intramuscular fat deposition, and visceral adiposity predict the outcomes of hepatocellular carcinoma. J Hepatol. 2015;63:131–140.CrossRefPubMed
23.
Watanabe J, Tatsumi K, Mitsuyoshi O, et al. The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer. Int J Colorectal Dis. 2014;29:343–51.CrossRefPubMed
24.
Rickles AS, Iannuzzi JC, Mironov O, et al. Visceral obesity and colorectal cancer: are we missing the boat with BMI? J Gastrointest Surg. 2013;17:133–43.CrossRefPubMed
25.
Ballian N, Lubner MG, Munoz A, et al. Visceral obesity is associated with outcomes of total mesorectal excision for rectal adenocarcinoma. J Surg Oncol. 2012;105:365–70.CrossRefPubMed
26.
Clark W, Siegel EM, Chen YA, et al. Quantitative measures of visceral adiposity and body mass index in predicting rectal cancer outcomes after neoadjuvant chemoradiation. J Am Coll Surg. 2013;216;1070–81.CrossRefPubMedPubMedCentral
27.
Watt DG, Martin JC, Park JH, et al. Neutrophil count is the most important prognostic component of the differential white cell count in patients undergoing elective surgery for colorectal cancer. Am J Surg. 2015;210:24–30.CrossRefPubMed
28.
Argilés JM, Busquets S, López-Soriano FJ. The pivotal role of cytokines in muscle wasting during cancer. Int J Biochem Cell Biol. 2005;37:2036–46.CrossRefPubMed
29.
30.
Cohen S, Nathan JA, Goldberg AL. Muscle wasting in disease: molecular mechanisms and promising therapies. Nat Rev Drug Discov. 2015;14:58–74.CrossRefPubMed
31.
Vaughan VC, Martin P, Lewandowski PA. Cancer cachexia: impact, mechanisms, and emerging treatments. J Cachexia Sarcopenia Muscle. 2013;4:95–109.CrossRefPubMed
32.
Roxburgh CSD, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6:149–63.CrossRefPubMed
33.
Richards CH, Roxburgh CSD, 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.CrossRefPubMedPubMedCentral
Metadata
Title
Prognostic Value of Computed Tomography: Measured Parameters of Body Composition in Primary Operable Gastrointestinal Cancers
Authors
Douglas Black, MBChB, MSc, MRCS
Craig Mackay, MBChB, MRCS, PhD
George Ramsay, MBChB, MRCS, PhD
Zaid Hamoodi, MBChB
Shayanthan Nanthakumaran, MBChB, FRCS, MD
Kenneth G. M. Park, MBChB, FRCS, MD
Malcolm A. Loudon, MBChB, FRCS, MD
Colin H. Richards, MBChB, FRCS, MD
Publication date
01-08-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-5829-z

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