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The Impact of Muscle and Adipose Tissue on Long-term Survival in Patients With Stage I to III Colorectal Cancer

Hopkins, Jessica J., M.D.1; Reif, Rebecca L.2; Bigam, David L., M.D.1; Baracos, Vickie E., Ph.D.3; Eurich, Dean T., Ph.D.4; Sawyer, Michael B., M.D.3

Diseases of the Colon & Rectum: May 2019 - Volume 62 - Issue 5 - p 549–560
doi: 10.1097/DCR.0000000000001352
Original Contribution: Colorectal Cancer
Denotes Associated Video Abstract
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BACKGROUND: Computed tomography-derived body composition parameters are emerging prognostic factors in colorectal cancer.

OBJECTIVE: This study aimed to determine the roles of sarcopenia, myosteatosis, and obesity as independent and overlapping parameters in stage I to III colorectal cancer.

DESIGN: This is a retrospective cohort study from a prospectively collected database. Multivariate Cox proportional hazards models were performed to assess the associations between body composition parameters and survival.

SETTINGS: All patients were seen in a tertiary care cancer center.

PATIENTS: Adult patients with stage I to III colorectal cancer, undergoing curative resection from 2007 to 2009, were included.

INTERVENTION: Computed tomography-derived quantification of skeletal muscle and adipose tissues was used to determine population-specific cutoffs for sarcopenia, myosteatosis, and total adiposity.

MAIN OUTCOME MEASURES: Primary outcome measures were overall, recurrence-free, and cancer-specific survival.

RESULTS: In the 968 patients included, there were a total of 254 disease recurrences and 350 deaths. Body mass index and CT-derived measures of adiposity did not result in worse survival outcomes. Sarcopenia was independently predictive of worse overall (HR, 1.45; 95% CI, 1.16-1.84), recurrence-free (HR, 1.32; 95% CI, 1.00–1.75), and cancer-specific survival (HR, 1.46; 95% CI, 1.09–1.94) in a multivariate model. Myosteatosis was also independently predictive of overall survival (HR, 1.53; 95% CI, 1.19–1.97). In a model considering joint effects of sarcopenia and myosteatosis, the presence of both predicted the worst overall (HR, 2.23; 95% CI, 1.62–3.06), recurrence-free (HR, 1.53; 95% CI, 1.06–2.21), and cancer-specific survival (HR, 2.40; 95% CI, 1.69–3.42) in a multivariate model.

LIMITATIONS: The limitations of this study are inherent in retrospective observational studies.

CONCLUSIONS: Sarcopenia and myosteatosis are independent predictors of worse survival in stage I to III colorectal cancer, and their joint effect is highly predictive of reduced overall, recurrence-free, and cancer-specific survival. See Video Abstract at

1Department of General Surgery, University of Alberta, Edmonton, Alberta, Canada

2Student, University of Alberta, Edmonton, Alberta, Canada

3Department of Oncology, University of Alberta, Edmonton, Alberta, Canada

4School of Public Health, University of Alberta, Edmonton, Alberta, Canada

Funding/Support: This work was funded by the Clinical Investigator Program and Alberta Health Flex at the University of Alberta.

Financial Disclosures: None reported.

Poster presentation at the meeting of ASCO GI, San Francisco, CA, January 18 to 21, 2018.

Correspondence: Jessica Hopkins, MD, 2D4.41 W.M.C., University of Alberta Hospital 8440-112 Street, Edmonton AB, Canada T6G 2B7. E-mail:

© 2019 The American Society of Colon and Rectal Surgeons