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


CONCLUSIONS
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.
University Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK. dhb@nhs.net.
Douglas
D
Black
University Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
Craig
C
Mackay
University Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
George
G
Ramsay
University Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
Zaid
Z
Hamoodi
University Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
Shayanthan
S
Nanthakumaran
University Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
Kenneth G M
KGM
Park
University Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
Malcolm A
MA
Loudon
University Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
Colin H
CH
Richards
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000368:Aged; D001823:Body Composition; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*