Skip to main content

Advertisement

SpringerLink
Log in

Barriers to the Interpretation of Body Composition in Colorectal Cancer: A Review of the Methodological Inconsistency and Complexity of the CT-Defined Body Habitus

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Measurement of body composition by computed tomography (CT) is an advancing field. Sarcopenia, myosteatosis, and visceral obesity (VO) have been identified as predictive of survival in colorectal cancer (CRC). We performed a systematic review of contemporary studies to characterize this association and highlight methodological inconsistencies.

Methods

MEDLINE and PubMed were queried for articles published from January 2000 on, with populations of resectable CRC and with CT-measured body composition and survival data. The study quality was assessed by two independent reviewers using the Newcastle–Ottawa Scale.

Results

Twenty studies met inclusion criteria, with a total of 8895 patients. Only two of the studies scored as high quality and nine as moderate quality. The remaining nine studies scored as low quality. Ten studies considered sarcopenia and 12 considered visceral obesity (VO). Cutoff points to define sarcopenia, myosteatosis, and VO were identified by optimal stratification, quartiles, or median values. The prevalence of sarcopenia varied from 15 to 60%, which based on study population and cutoff value used. Sarcopenia was associated with worse overall and disease-free survival in eight of the included studies. Myosteatosis was considered in three studies with a prevalence of 19–78%. It was significantly predictive of worse overall and disease-free survival in all three studies. VO had a prevalence of 14–70% and was inconsistently predictive of survival outcomes.

Conclusions

There is a lack of methodological consistency within the currently published literature. Despite this, sarcopenia and myosteatosis, but not VO, are consistently associated with worse survival outcomes, when population and cancer-specific cutoffs are utilized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Rutten IJG, Ubachs J, Kruitwagen R, Beets-Tan RGH, Olde Damink SWM, Van Gorp T. Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer. J Cachexia Sarcopenia Muscle. 2017;8(4):630–638.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Vrieling A, Kampman E, Knijnenburg NC, et al. (2016) Body Composition in Relation to Clinical Outcomes in Renal Cell Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus. https://doi.org/10.1016/j.euf.2016.11.009

    PubMed  Google Scholar 

  3. Caan BJ, Meyerhardt JA, Kroenke CH, et al. Explaining the obesity paradox: the association between body composition and colorectal cancer survival (C-SCANS Study). Cancer Epidemiol Biomarkers Prev. 2017;26(7):1008–1015.

    Article  PubMed  Google Scholar 

  4. Cespedes Feliciano EM, Kroenke CH, Meyerhardt JA, et al. (2017) Association of systemic inflammation and sarcopenia with survival in nonmetastatic colorectal cancer: results from the C SCANS Study. JAMA Oncol. 3(12):e172319

    Article  Google Scholar 

  5. McSorley ST, Black DH, Horgan PG, McMillan DC (2017) The relationship between tumour stage, systemic inflammation, body composition and survival in patients with colorectal cancer. Clin Nutr. https://doi.org/10.1016/j.clnu.2017.05.017.

    PubMed  Google Scholar 

  6. Black D, Mackay C, Ramsay G, et al. Prognostic value of computed tomography: measured parameters of body composition in primary operable gastrointestinal cancers. Ann Surg Oncol. 2017;24(8):2241–251.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Malietzis G, Currie AC, Athanasiou T, et al. Influence of body composition profile on outcomes following colorectal cancer surgery. Br J Surg. 2016;103(5):572–80.

    Article  CAS  PubMed  Google Scholar 

  8. 8. Boer BC, de Graaff F, Brusse-Keizer M, et al. Skeletal muscle mass and quality as risk factors for postoperative outcome after open colon resection for cancer. Int J Colorectal Dis. Jun 2016;31(6):1117–24.

    Article  CAS  PubMed  Google Scholar 

  9. Miyamoto Y, Baba Y, Sakamoto Y, et al. Sarcopenia is a Negative Prognostic Factor After Curative Resection of Colorectal Cancer. Ann Surg Oncol. 2015;22:2663–68.

    Article  PubMed  Google Scholar 

  10. 10. Martin L, Birdsell L, Macdonald N, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539–47.

    Article  PubMed  Google Scholar 

  11. van Vledder MG, Levolger S, Ayez N, Verhoef C, Tran TC, Ijzermans JN. Body composition and outcome in patients undergoing resection of colorectal liver metastases. Br J Surg. 2012;99(4):550–7.

    Article  PubMed  Google Scholar 

  12. Lodewick TM, van Nijnatten TJ, van Dam RM, et al. Are sarcopenia, obesity and sarcopenic obesity predictive of outcome in patients with colorectal liver metastases? HPB. 2015;17(5):438–46.

    Article  PubMed  Google Scholar 

  13. Prado CMM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9(7):629–35.

    Article  PubMed  Google Scholar 

  14. Buettner S, Wagner D, Kim Y, et al. (2016) Inclusion of sarcopenia outperforms the modified frailty index in predicting 1-year mortality among 1,326 patients undergoing gastrointestinal surgery for a malignant indication. J Am Coll Surg. 222(4):397–407

    Article  PubMed  Google Scholar 

  15. Jung HW, Kim JW, Kim JY, et al. Effect of muscle mass on toxicity and survival in patients with colon cancer undergoing adjuvant chemotherapy. Supportive Care in Cancer. 2015;23(3):687–94.

    Article  PubMed  Google Scholar 

  16. Sabel SS, Terjimanian M, Conlon ASC, et al. Analytic morphometric assessment of patients undergoing colectomy for colon cancer. J Surg Oncol. 2013;108:169–75.

    Article  PubMed  Google Scholar 

  17. Clark W, Siegel EM, Chen YA, et al. Quantitative measures of visceral adiposity and body mass index in predicting rectal cancer outcomes after neoadjuvant chemoradiation. J Am Coll Surg. 2013;216(6):1070–81.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Peng PD, van Vledder MG, Tsai S, et al. Sarcopenia negatively impacts short-term outcomes in patients undergoing hepatic resection for colorectal liver metastasis. HPB. 2011;13(7):439–46.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Choe EK, Park KJ, Ryoo SB, Moon SH, Oh HK, Han EC. Prognostic impact of changes in adipose tissue areas after colectomy in colorectal cancer patients. J Korean Med Sci. 2016;31(10):1571–578.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Moon HG, Hu YT, Jeong CY, et al. Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann Surg Oncol. 2008;15(7):1918–922.

    Article  PubMed  Google Scholar 

  21. Ballian N, Lubner MG, Munoz A, et al. Visceral Obesity is Associated With Outcomes of Total Mesorectal Excision for Rectal Adenocarcinoma. J Surg Oncol. 2012;105:365–70.

    Article  PubMed  Google Scholar 

  22. Yamamoto N, Fujii S, Sato T, et al. Impact of body mass index and visceral adiposity on outcomes in colorectal cancer. Asia Pac J Clin Oncol. 2012;8(4):337–45.

    Article  PubMed  Google Scholar 

  23. Park SW, Lee HL, Doo EY, et al. Visceral obesity predicts fewer lymph node metastases and better overall survival in colon cancer. J Gastrointest Surg. 2015;19(8):1513–521.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Jeong GY, Kim JW, Lee SY, Park HS, Han HS, Hwang DY. Inverse correlation between cancer size and abdominal obesity in colorectal cancer cases. Asian Pacific J Cancer Prev. 2016;17:4025–30.

    Google Scholar 

  25. Rickles AS, Iannuzzi JC, Mironov O, et al. (2013) Visceral obesity and colorectal cancer: are we missing the boat with BMI? J Gastrointest Surg.17(1):133–43

    Article  PubMed  Google Scholar 

  26. Lee CS, Murphy DJ, McMahon C, et al. Visceral adiposity is a risk factor for poor prognosis in colorectal cancer patients receiving adjuvant chemotherapy. J Gastrointest Cancer. 2015;46(3):243–50.

    Article  CAS  PubMed  Google Scholar 

  27. Arrazubi V, Suarez J, Novas P, Perez-Hoyos MT, Vera R, Martinez Del Prado P. Chemoradiation of rectal cancer. Minerva Chir. 2013;68(1):11–26.

    CAS  PubMed  Google Scholar 

  28. Cespedes Feliciano EM, Kroenke CH, Meyerhardt JA, et al. Metabolic dysfunction, obesity, and survival among patients with early-stage colorectal cancer. J Clin Oncol. 2016;34(30):3664–71.

    Article  PubMed Central  Google Scholar 

  29. Miyamoto Y, Baba Y, Sakamoto Y, et al. Sarcopenia is a negative prognostic factor after curative resection of colorectal cancer. Ann Surg Oncol. 2015;22(8):2663–668.

    Article  PubMed  Google Scholar 

  30. Doyle SL, Bennett AM, Donohoe CL, et al. Establishing computed tomography-defined visceral fat area thresholds for use in obesity-related cancer research. Nutr Res. 2013;33(3):171–79.

    Article  CAS  PubMed  Google Scholar 

  31. Ballian N, Lubner MG, Munoz A, et al. Visceral obesity is associated with outcomes of total mesorectal excision for rectal adenocarcinoma. J Surg Oncol. 2012;105(4):365–70.

    Article  PubMed  Google Scholar 

  32. Malietzis G, Johns N, Al-Hassi HO, et al. Low muscularity and myosteatosis is related to the host systemic inflammatory response in patients undergoing surgery for colorectal cancer. Ann Surg. 2016;263(2):320–25.

    Article  PubMed  Google Scholar 

  33. Malietzis G, Johns N, Al-Hassi HO, et al. Low muscularity and myosteatosis is related to the host systemic inflammatory response in patients undergoing surgery for colorectal cancer. Ann Surg. 2016;263(2):320–5.

    Article  PubMed  Google Scholar 

  34. Shen W, Punyanitya M, Wang Z, et al. (2004) Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol 97(6):2333–338.

    Article  PubMed  Google Scholar 

  35. Baracos V. Psoas as a sentinel muscle for sarcopenia: a flawed premise. J Cachexia Sarcopenia Muscle. 2017;8:527–28.

    Article  PubMed  PubMed Central  Google Scholar 

  36. van der Werf A, Dekker IM, Meijerink MR, Wierdsma NJ, de van der Schueren MAE, Langius JAE (2017) Skeletal muscle analyses: agreement between non-contrast and contrast CT scan measurements of skeletal muscle area and mean muscle attenuation. Clin Physiol Funct Imaging. https://doi.org/10.1111/cpf.12422

    PubMed  Google Scholar 

  37. van Vugt JLA, Coebergh van den Braak RRJ, Schippers HJW, et al. (2017) Contrast-enhancement influences skeletal muscle density, but not skeletal muscle mass, measurements on computed tomography. Clin Nutr. https://doi.org/10.1016/j.clnu.2017.07.007

    PubMed  Google Scholar 

  38. Huang DD, Chen XX, Chen XY, et al. Sarcopenia predicts 1-year mortality in elderly patients undergoing curative gastrectomy for gastric cancer: a prospective study. J Cancer Res Clin Oncol. 2016;142(11):2347–356.

    Article  CAS  PubMed  Google Scholar 

  39. Chen FF, Zhang FY, Zhou XY, Shen X, Yu Z, Zhuang CL. Role of frailty and nutritional status in predicting complications following total gastrectomy with D2 lymphadenectomy in patients with gastric cancer: a prospective study. Langenbecks Arch Surg. 2016;401(6):813–22.

    Article  PubMed  Google Scholar 

  40. Zhuang CL, Huang DD, Pang WY, et al. Sarcopenia is an independent predictor of severe postoperative complications and long-term survival after radical gastrectomy for gastric cancer: analysis from a large-scale cohort. Medicine. 2016;95(13):e3164.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Reisinger KW, Derikx JP, van Vugt JL, et al. Sarcopenia is associated with an increased inflammatory response to surgery in colorectal cancer. Clin Nutr. 2016;35:924–27.

    Article  PubMed  Google Scholar 

  42. Haram A, Boland MR, Kelly ME, Bolger JC, Waldron RM, Kerin MJ (2017) The prognostic value of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review. J Surg Oncol. 115(4), 470–479

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

Jessica Hopkins is funded by the Clinical Investigator Program through Alberta Health Services.

Disclosures

There are no commercial disclaimers.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Alberta, Edmonton, AB, Canada

    Jessica J. Hopkins BSc, MD, Daniel Skubleny BSc, MD & David L. Bigam BSc, MD

  2. School of Public Health, University of Alberta, Edmonton, AB, Canada

    Jessica J. Hopkins BSc, MD & Dean T. Eurich BA, MSc, PhD

  3. Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada

    Vickie E. Baracos BSc, PhD & Michael B. Sawyer BSc, MD

Authors
  1. Jessica J. Hopkins BSc, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel Skubleny BSc, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David L. Bigam BSc, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vickie E. Baracos BSc, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dean T. Eurich BA, MSc, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael B. Sawyer BSc, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jessica J. Hopkins BSc, MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hopkins, J.J., Skubleny, D., Bigam, D.L. et al. Barriers to the Interpretation of Body Composition in Colorectal Cancer: A Review of the Methodological Inconsistency and Complexity of the CT-Defined Body Habitus. Ann Surg Oncol 25, 1381–1394 (2018). https://doi.org/10.1245/s10434-018-6395-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-018-6395-8

Keywords

Search

Navigation