Abstract
Objective
This study evaluated the clinical implications of sarcopenia for patients with rectal
cancer according to cancer progression.
Summary Background Data
The negative impact of body composition on long-term outcome has been demonstrated
for various malignancies.
Methods
We retrospectively reviewed 708 patients with rectal cancer who underwent curative
resection at our institution between 2003 and 2020. Factors contributing to long-term
outcomes and the incidence of secondary cancer (ISC) were analyzed. Psoas muscle mass
index (PMI) was assessed using preoperative computed tomography. Sarcopenia was defined
using the PMI cut-off values for Asian adults (6.36 cm2/m2 for males and 3.92 cm2/m2 for females).
Results
Sarcopenia was identified in 306 patients (43.2%). Sarcopenia was associated with
advanced age, low body mass index, smoking history, and advanced T-stage. Multivariate
analysis showed sarcopenia was an independent poor prognostic factor for OS (HR 1.71;
P = .0102) and cancer-specific survival (HR 1.64; P = .0490). Patients with sarcopenia had significantly higher mortality due to cancer-related
death in stages III and IV, whereas non-rectal cancer-related death, including secondary
cancer, was markedly increased in stage 0-II sarcopenic rectal patients. Five-year
cumulative ISC in patients with and without sarcopenia was 11.8% and 5.9%, respectively.
Multivariate analysis revealed that sarcopenia was an independent predictive factor
for ISC (HR 2.05; P = .0063).
Conclusions
Sarcopenia helps predict survival outcomes and cause of death according to cancer
stage for patients with middle/lower rectal cancer who underwent radical surgery.
Furthermore, sarcopenia increased the development of secondary cancer in those patients.
Keywords
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Article info
Publication history
Published online: October 21, 2022
Accepted:
October 4,
2022
Received in revised form:
September 26,
2022
Received:
August 13,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
