title: Influence of body composition profile on outcomes following colorectal cancer surgery.
abstract: BACKGROUND
  Muscle depletion is characterized by reduced muscle mass (myopenia), and increased infiltration by intermuscular and intramuscular fat (myosteatosis). This study examined the role of particular body composition profiles as prognostic markers for patients with colorectal cancer undergoing curative resection.
  
  
  METHODS
  Patients with colorectal cancer undergoing elective surgical resection between 2006 and 2011 were included. Lumbar skeletal muscle index (LSMI), visceral adipose tissue (VAT) surface area and mean muscle attenuation (MA) were calculated by analysis of CT images. Reduced LSMI (myopenia), increased VAT (visceral obesity) and low MA (myosteatosis) were identified using predefined sex-specific skeletal muscle index values. Univariable and multivariable Cox regression models were used to determine the role of different body composition profiles on outcomes.
  
  
  RESULTS
  Some 805 patients were identified, with a median follow-up of 47 (i.q.r. 24·9-65·6) months. Multivariable analysis identified myopenia as an independent prognostic factor for disease-free survival (hazard ratio (HR) 1·53, 95 per cent c.i. 1·06 to 2·39; P = 0·041) and overall survival (HR 1·70, 1·25 to 2·31; P < 0·001). The presence of myosteatosis was associated with prolonged primary hospital stay (P = 0·034), and myopenic obesity was related to higher 30-day morbidity (P = 0·019) and mortality (P < 0·001) rates.
  
  
  CONCLUSIONS
  Myopenia may have an independent prognostic effect on cancer survival for patients with colorectal cancer. Muscle depletion may represent a modifiable risk factor in patients with colorectal cancer and needs to be targeted as a relevant endpoint of health recommendations.
authors.affiliation: Department of Surgery, St Mark's Hospital, Harrow, London, UK.|Department of Surgery and Cancer, Imperial College, London, UK.
authors.forename: G
authors.identifier: http://orcid.org/0000-0003-2028-2677
authors.initials: G
authors.lastname: Malietzis
authors.affiliation: Department of Surgery, St Mark's Hospital, Harrow, London, UK.|Department of Surgery and Cancer, Imperial College, London, UK.
authors.forename: A C
authors.initials: AC
authors.lastname: Currie
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Athanasiou
authors.affiliation: Department of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: N
authors.initials: N
authors.lastname: Johns
authors.affiliation: Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK.
authors.forename: N
authors.initials: N
authors.lastname: Anyamene
authors.affiliation: Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK.
authors.forename: R
authors.initials: R
authors.lastname: Glynne-Jones
authors.affiliation: Department of Surgery, St Mark's Hospital, Harrow, London, UK.|Department of Surgery and Cancer, Imperial College, London, UK.
authors.forename: R H
authors.initials: RH
authors.lastname: Kennedy
authors.affiliation: Department of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: K C H
authors.initials: KC
authors.lastname: Fearon
authors.affiliation: Department of Surgery, St Mark's Hospital, Harrow, London, UK.|Department of Surgery and Cancer, Imperial College, London, UK.
authors.forename: J T
authors.initials: JT
authors.lastname: Jenkins
mesh_terms: D000368:Aged; D001823:Body Composition; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D050152:Intra-Abdominal Fat; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018482:Muscle, Skeletal; D056128:Obesity, Abdominal / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D011183:Postoperative Complications / Q000209:etiology; D015995:Prevalence; D011379:Prognosis; D012007:Rectum / Q000601:surgery*; D055948:Sarcopenia / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome