Quantitative assessment of mesorectal fat: new prognostic biomarker in patients with mid-to-lower rectal cancer
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To investigate the impact of mesorectal fat area (MFA) on oncologic outcomes in patients with mid-to-lower rectal cancer who received curative-intent surgery.
Patients with mid-to-lower rectal cancer who underwent preoperative abdominopelvic computed tomography (CT) and curative-intent surgery in 2011 were divided into two groups by tumour recurrence (group A) or no recurrence (group B) during a 5-year follow-up. Visceral fat area (VFA) and MFA were measured on preoperative CT and cutoff values were calculated using the Youden index. Univariate and multivariate regression analyses including BMI, VFA, and MFA were performed to investigate meaningful prognostic biomarkers. The Kaplan–Meier method with log-rank testing was used to validate prognostic biomarkers.
Group A contained 42 patients and group B had 155 patients. Cutoff values were 25 kg/m2 for BMI, 130 cm2 for VFA, and 10 cm2 for MFA using the Youden index. On multivariate Cox regression analysis, MFA (odds ratio [OR] = 0.426, p = 0.010), TNM stage (p = 0.027), and perioperative complication grade (p = 0.028) were significantly different between groups. BMI and VFA did not show significant differences. By the Kaplan–Meier method with log-rank testing, disease-free survival (DFS) was significantly longer in patients with MFA ≥10 cm2 compared to patients with MFA <10 cm2 (p = 0.021), with no significant difference in overall survival (OS).
MFA was an independent biomarker for predicting DFS in patients who underwent curative-intent surgery for mid-to-lower rectal cancer.
• Mesorectal fat area is associated with the prognosis of rectal cancer patients.
• Mesorectal fat area can be calculated easily in pre-operative CT scan.
• Predicting prognosis of the cancer patient before operation is important.
KeywordsIntra-abdominal fat Body mass index Colorectal neoplasms Digestive system surgical procedures
American Society of Anesthesiologists
Body mass index
Disease free survival
Low anterior resection
Mesorectal fat area
Total mesorectal excision
Ultralow anterior resection
Visceral fat area
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Dr. Myeong-Jin Kim, Severance Hospital.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
Yunho Rho, Yonsei University, College of Medicine, kindly provided statistical advice for this manuscript.
Written informed consent was waived by the institutional review board.
Institutional review board approval was obtained.
• diagnostic or prognostic study
• performed at one institution
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