Prognostic value of adipose tissue and muscle mass in advanced colorectal cancer: a post hoc analysis of two non-randomized phase II trials

Nicolas Charette, Caroline Vandeputte, Lieveke Ameye, Camille Van Bogaert, Jonathan Krygier, Thomas Guiot, Amélie Deleporte, Thierry Delaunoit, Karen Geboes, Jean-Luc Van Laethem, Marc Peeters, Gauthier Demolin, Stéphane Holbrechts, Patrick Flamen, Marianne Paesmans, Alain Hendlisz, Nicolas Charette, Caroline Vandeputte, Lieveke Ameye, Camille Van Bogaert, Jonathan Krygier, Thomas Guiot, Amélie Deleporte, Thierry Delaunoit, Karen Geboes, Jean-Luc Van Laethem, Marc Peeters, Gauthier Demolin, Stéphane Holbrechts, Patrick Flamen, Marianne Paesmans, Alain Hendlisz

Abstract

Background: The prognostic value of body composition in cancer patients has been widely studied during the last decade. The main finding of these studies is that sarcopenia, or skeletal muscle depletion, assessed by CT imaging correlates with a reduced overall survival (OS). By contrast, the prognostic value of fat mass remains ill-defined. This study aims to analyze the influence of body composition including both muscle mass and adipose tissue on OS in a homogeneous population of advanced colorectal cancer (CRC) patients.

Methods: Among 235 patients with chemorefractory advanced CRC included in the SoMore and RegARd-C trials, body composition was assessed in 217 patients on baseline CT images. The relationship between body composition (sarcopenia, muscle density, subcutaneous and visceral fat index and density), body mass index (BMI) and OS were evaluated.

Results: Patients with a higher BMI had a better OS (≥30 versus < 30, HR: 0.50; 0.33-0.76). Those with low muscle index and muscle density had an increased mortality (HR: 2.06; 1.45-2.93 and HR: 1.54; 1.09-2.18, respectively). Likewise, low subcutaneous and visceral fat index were associated with an increased risk of dying (HR: 1.63; 1.23-2.17 and 1.48; 1.09-2.02 respectively), as were a high subcutaneous and visceral adipose tissue density (HR: 1.93; 1.44-2.57 and 2.40; 1.79-3.20 respectively). In multivariate analysis, a high visceral fat density was the main predictor of poor survival.

Conclusions: Our results confirm the protective role of obesity in CRC patients at an advanced stage, as well as the negative prognostic impact of muscle depletion on survival. More importantly, our data show for the first time that visceral adipose tissue density is an important prognostic factor in metastatic CRC.

Trial registration: NCT01290926 , 07/02/2011 and NCT01929616 , 28/08/2013.

Keywords: Adipose tissue; Chemotherapy; Colorectal cancer; Myosteatosis; Obesity; Prognosis; Sarcopenia.

Conflict of interest statement

Ethics approval and consent to participate

This study has been approved by the ethics committee of Institut Jules Bordet and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained for all participants before inclusion in the SoMore or RegARd-C trials.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
CT images of the third lumbar vertebra region in a sarcopenic (a) and a non-sarcopenic (b) patient
Fig. 2
Fig. 2
Survival curves based on skeletal muscle index (a), muscle density (b), subcutaneous fat index (c), visceral fat index (d), subcutaneous fat density (e) and visceral fat density (f). Patients with skeletal muscle index and muscle density below the thresholds had an increased mortality. Low subcutaneous and visceral fat index were also associated with an increased risk of dying. Finally, a high subcutaneous and visceral fat density also correlated with mortality

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