Low radiographic muscle density is associated with lower overall and disease-free survival in early-stage colorectal cancer patients.
BACKGROUND
In cancer patients with a poor prognosis, low skeletal muscle radiographic density is associated with higher mortality. Whether this association also holds for early-stage cancer is not very clear. We aimed to study the association between skeletal muscle density and overall mortality among early-stage (stage I-III) colorectal cancer (CRC) patients. Furthermore, we investigated the association between skeletal muscle density and both CRC-specific mortality and disease-free survival in a subset of the study population.


METHODS
Skeletal muscle density was assessed in 1681 early-stage CRC patients, diagnosed between 2006 and 2015, using pre-operative computed tomography images. Adjusted Cox proportional hazard models were used to evaluate the association between muscle density and overall mortality, CRC-specific mortality and disease-free survival.


RESULTS
The median follow-up time was 48 months (range 0-119 months). Low muscle density was detected in 39% of CRC patients. Low muscle density was significantly associated with higher mortality (low vs. normal: adjusted HR 1.91, 95% CI 1.53-2.38). After stratification for comorbidities, the association was highest in patients with ≥ 2 comorbidities (HR 2.11, 95% CI 1.55-2.87). Furthermore, low skeletal muscle density was significantly associated with poorer disease-free survival (HR 1.68, 95% CI 1.14-2.47), but not with CRC-specific mortality (HR 1.68, 95% CI 0.89-3.17) in a subset of the study population.


CONCLUSION
In early-stage CRC patients, low muscle density was significantly associated with higher overall mortality, and worse disease-free survival.
['van Baar|Harm|H|http://orcid.org/0000-0003-2705-5442', 'Beijer|S|S|', 'Bours|M J L|MJL|', 'Weijenberg|M P|MP|', 'van Zutphen|M|M|', 'van Duijnhoven|F J B|FJB|', 'Slooter|G D|GD|', 'Pruijt|J F M|JFM|', 'Dronkers|J J|JJ|', 'Haringhuizen|A|A|', 'Spillenaar Bilgen|E J|EJ|', 'Hansson|B M E|BME|', 'de Wilt|J H W|JHW|', 'Kampman|E|E|', 'Winkels|R M|RM|']
D000368:Aged D000369:Aged, 80 and over D003110:Colonic Neoplasms D015179:Colorectal Neoplasms D018572:Disease-Free Survival D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D018482:Muscle, Skeletal D009367:Neoplasm Staging D011379:Prognosis D016016:Proportional Hazards Models D011446:Prospective Studies D015996:Survival Rate D014057:Tomography, X-Ray Computed
Survival Colorectal cancer Mortality Skeletal muscle density