Higher visceral fat area/subcutaneous fat area ratio measured by computed tomography is associated with recurrence and poor survival in patients with mid and low rectal cancers

The Ratio of Visceral to Subcutaneous Adipose Tissue Is Associated With Postoperative Anastomotic Leakage in Patients With Rectal Cancer With Gender Differences in Opposite Direction

BACKGROUND

Anastomotic leakage (AL) is a severe postoperative complication in colorectal cancer and exerts negative impacts on patients' outcomes. Studies have found that body composition measured by CT images was associated with increased overall postoperative complications in colorectal cancer; however, few focused on postoperative AL in rectal cancer. This study aimed to explore the association between body composition parameters measured by CT images and postoperative AL in patients with rectal cancer, with an emphasis on subgroup analysis by gender.

METHODS

From February 2014 to January 2020, a total of 444 patients with rectal adenocarcinoma who underwent radical proctectomy were included. Out of all patients, 21 developed AL after surgery. Body composition parameters, including the areas, mean CT values, height-normalized indices of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), intramuscular adipose tissue (IMAT) and skeletal muscle (SM) were derived from preoperative contrast-enhanced arterial phase CT images at the third lumbar level. The ratio of visceral to subcutaneous adipose tissue (VSR) was calculated. Clinical and body composition parameters were compared between the AL group and the non-AL group in all patients and separately in different genders.

RESULTS

Body composition parameters were not significantly different in the AL group and the non-AL group in all patients. However, most body composition parameters were significantly different between male and female patients. After separately analyzing by gender, VSR was significantly associated with postoperative AL in male and female. After multivariate regression, VSR remained an independent predictor for AL (OR: 0.1, p = 0.041 for male and OR: 39.1, p = 0.045 for female).

CONCLUSION

The VSR measured by CT images is an independent predictor for postoperative AL in patients with rectal cancer; however, it shows gender differences in opposite directions, serving as a protective factor in males, whereas as a risk factor in females.

Predicting 3-year all-cause mortality in rectal cancer patients based on body composition and machine learning

Objectives

The composition of abdominal adipose tissue and muscle mass has been strongly correlated with the prognosis of rectal cancer. This study aimed to develop and validate a machine learning (ML) predictive model for 3-year all-cause mortality after laparoscopic total mesorectal excision (LaTME).

Methods

Patients who underwent LaTME surgery between January 2018 and December 2020 were included and randomly divided into training and validation cohorts. Preoperative computed tomography (CT) image parameters and clinical characteristics were collected to establish seven ML models for predicting 3-year survival post-LaTME. The optimal model was determined based on the area under the receiver operating characteristic curve (AUROC). The SHAPley Additive exPlanations (SHAP) values were utilized to interpret the optimal model.

Results

A total of 186 patients were recruited and divided into a training cohort (70%, n = 131) and a validation cohort (30%, n = 55). In the training cohort, the AUROCs of the seven ML models ranged from 0.894 to 0.949. In the validation cohort, the AUROCs ranged from 0.727 to 0.911, with the XGBoost model demonstrating the best predictive performance: AUROC = 0.911. SHAP values revealed that subcutaneous adipose tissue index (SAI), visceral adipose tissue index (VAI), skeletal muscle density (SMD), visceral-to-subcutaneous adipose tissue ratio (VSR), and subcutaneous adipose tissue density (SAD) were the five most important variables influencing all-cause mortality post-LaTME.

Conclusion

By integrating body composition, multiple ML predictive models were developed and validated for predicting all-cause mortality after rectal cancer surgery, with the XGBoost model exhibiting the best performance.

Visceral to subcutaneous fat area ratio predicts early postoperative small bowel obstruction after total gastrectomy for cardia cancer

OBJECTIVE

We aimed to investigate the relationship between the visceral to subcutaneous fat area ratio (V/S ratio) and incidence of early postoperative small bowel obstruction (EPSBO) following total gastrectomy for cardia cancer.

METHODS

We conducted a retrospective analysis among patients with cardia cancer who underwent elective total gastrectomy with esophagojejunostomy Roux-en-Y anastomosis at Nanjing Yimin Hospital between November 2019 and April 2024. Preoperative, intraoperative, and postoperative factors were meticulously monitored. The V/S ratio was calculated using computed tomography scans at the umbilical level with Slice-O-Matic software (Tomovision, Montreal, Canada). Statistical analyses included logistic regression and receiver operating characteristic (ROC) curve analysis.

RESULTS

Among 175 patients, 27 (15.4%) developed EPSBO. The V/S ratio was significantly higher in the EPSBO group (1.76 ± 1.05 vs. 1.01 ± 0.54). Logistic regression identified the V/S ratio as a significant predictor of EPSBO (odds ratio [OR] = 1.612, 95% [CI]: 1.102-1.605). ROC curve analysis demonstrated high sensitivity (92%) and specificity (100%) for the V/S ratio in predicting EPSBO, with a 0.83 AUC.

CONCLUSIONS

Our findings indicated a higher V/S ratio was a significant predictor of EPSBO following total gastrectomy for cardia cancer. Preoperative assessment of the V/S ratio can inform risk stratification and guide targeted interventions to improve postoperative outcomes.

Post-diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis

The adiposity influence on colorectal cancer prognosis remains poorly characterised. We performed a systematic review and meta-analysis on post-diagnosis adiposity measures (body mass index [BMI], waist circumference, waist-to-hip ratio, weight) or their changes and colorectal cancer outcomes. PubMed and Embase were searched through 28 February 2022. Random-effects meta-analyses were conducted when at least three studies had sufficient information. The quality of evidence was interpreted and graded by the Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel. We reviewed 124 observational studies (85 publications). Meta-analyses were possible for BMI and all-cause mortality, colorectal cancer-specific mortality, and cancer recurrence/disease-free survival. Non-linear meta-analysis indicated a reverse J-shaped association between BMI and colorectal cancer outcomes (nadir at BMI 28 kg/m2). The highest risk, relative to the nadir, was observed at both ends of the BMI distribution (18 and 38 kg/m2), namely 60% and 23% higher risk for all-cause mortality; 95% and 26% for colorectal cancer-specific mortality; and 37% and 24% for cancer recurrence/disease-free survival, respectively. The higher risk with low BMI was attenuated in secondary analyses of RCTs (compared to cohort studies), among studies with longer follow-up, and in women suggesting potential methodological limitations and/or altered physiological state. Descriptively synthesised studies on other adiposity-outcome associations of interest were limited in number and methodological quality. All the associations were graded as limited (likelihood of causality: no conclusion) due to potential methodological limitations (reverse causation, confounding, selection bias). Additional well-designed observational studies and interventional trials are needed to provide further clarification.

Body mass index and survival among patients with advanced biliary tract cancer: a single-institutional study with nationwide data-based validation

BACKGROUND

Excess body weight may modulate the progression of various cancer types. The prognostic relevance of body mass index (BMI) has not been fully examined in patients with biliary tract cancer.

METHODS

Using a single-institutional cohort of 360 patients receiving gemcitabine-based chemotherapy for advanced biliary tract cancer, we examined the association of BMI with overall survival (OS). Using the Cox regression model with adjustment for potential confounders, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for OS according to BMI. The findings were validated using a Japanese nationwide inpatient database including 8324 patients treated at 201 hospitals.

RESULTS

In the clinical cohort, BMI was not associated with OS (Ptrend = 0.34). Compared to patients with BMI = 18.5-24.9 kg/m2, patients with BMI < 18.5 kg/m2 and ≥ 25.0 kg/m2 had adjusted HRs for OS of 1.06 (95% CI, 0.78-1.45) and 1.01 (95% CI, 0.74-1.39), respectively. There was no evidence on a non-linear relationship between BMI and OS (Pnonlinearity = 0.63). In the nationwide cohort, the null findings were validated (Ptrend = 0.18) with adjusted HRs of 1.07 (95% CI, 0.98-1.18) for BMI < 18.5 kg/m2 and 1.05 (95% CI, 0.96-1.14) for BMI ≥ 25.0 kg/m2 (vs. BMI = 18.5-24.9 kg/m2). In the clinical cohort, BMI was not associated with progression-free survival (Ptrend = 0.81).

CONCLUSIONS

BMI was not associated with survival outcomes of patients with advanced biliary tract cancer. Further research is warranted incorporating more detailed body composition metrics to explore the prognostic role of adiposity in biliary tract cancer.

Study on sex differences and potential clinical value of three-dimensional computerized tomography pelvimetry in rectal cancer patients

BACKGROUND

Laparoscopic rectal cancer radical surgery is a complex procedure affected by various factors. However, the existing literature lacks standardized parameters for the pelvic region and soft tissues, which hampers the establishment of consistent conclusions.

AIM

To comprehensively assess 16 pelvic and 7 soft tissue parameters through computerized tomography (CT)-based three-dimensional (3D) reconstruction, providing a strong theoretical basis to address challenges in laparoscopic rectal cancer radical surgery.

METHODS

We analyzed data from 218 patients who underwent radical laparoscopic surgery for rectal cancer, and utilized CT data for 3D pelvic reconstruction. Specific anatomical points were carefully marked and measured using advanced 3D modeling software. To analyze the pelvic and soft tissue parameters, we employed statistical methods including paired sample t-tests, Wilcoxon rank-sum tests, and correlation analysis.

RESULTS

The investigation highlighted significant sex disparities in 14 pelvic bone parameters and 3 soft tissue parameters. Males demonstrated larger measurements in pelvic depth and overall curvature, smaller measurements in pelvic width, a larger mesorectal fat area, and a larger anterior-posterior abdominal diameter. By contrast, females exhibited wider pelvises, shallower depth, smaller overall curvature, and an increased amount of subcutaneous fat tissue. However, there were no significant sex differences observed in certain parameters such as sacral curvature height, superior pubococcygeal diameter, rectal area, visceral fat area, waist circumference, and transverse abdominal diameter.

CONCLUSION

The reconstruction of 3D CT data enabled accurate pelvic measurements, revealing significant sex differences in both pelvic and soft tissue parameters. This study design offer potential in predicting surgical difficulties and creating personalized surgical plans for male rectal cancer patients with a potentially "difficult pelvis", ultimately improving surgical outcomes. Further research and utilization of these parameters could lead to enhanced surgical methods and patient care in laparoscopic rectal cancer radical surgery.

Effect of low visceral fat area on long-term survival of stage I-III colorectal cancer

OBJECTIVE

The prognostic significance of a low visceral fat area (VFA) in colorectal cancer (CRC) remains unclear. The aim of this study was to evaluate the prognostic effects of a low VFA on the long-term outcomes of patients with CRC after laparoscopic surgery.

METHODS

This retrospective study included 306 patients with stages I-III CRC who underwent R0 resection. VFA was preoperatively measured via computed tomography using image processing software. Relapse-free survival (RFS) and overall survival (OS) rates were analyzed using the Cox proportional hazards model and Kaplan-Meier curves.

RESULTS

Low VFA was identified in 153 patients. The low VFA group had significantly lower RFS and OS rates than did the high VFA group (5-y RFS rates: 72 versus 89%, P = 0.0002; 5-y OS rates: 72 versus 92%, P = 0.0001). The independent significant predictors of RFS were T3 or T4 disease (hazard ratio [HR], 2.75; 95% confidence interval [CI], 1.12-6.76; P = 0.027), stage III CRC (HR, 3.49; 95% CI, 1.82-6.69; P < 0.001), low psoas muscle index (PMI; HR, 2.12; 95% CI, 1.19-3.79; P = 0.011), and low VFA (HR, 2.12; 95% CI, 1.16-3.86; P = 0.014). The independent significant predictors of OS were age ≥65 y (HR, 2.59; 95% CI, 1.13-5.92, P = 0.024), carbohydrate antigen 19-9 levels ≥37 ng/mL (HR, 2.32; 95% CI, 1.18-4.58; P = 0.015), stage III CRC (HR, 2.66; 95% CI, 1.37-5.17; P = 0.004), low PMI (HR, 2.00; 95% CI, 1.06-3.77; P = 0.031), and low VFA (HR, 2.42; 95% CI, 1.24-4.70; P = 0.009).

CONCLUSION

A low preoperative VFA was significantly associated with worse RFS and OS rates in patients who underwent CRC resection.

The impact of adipose tissue distribution on endometrial cancer: a systematic review

Introduction

Endometrial cancer (EC) is the most common gynecological cancer with a rising incidence, attributed to advanced life expectancy and obesity. Adipose tissue (AT) is an important endocrine organ, and its metabolic activity is affected by the different anatomical distribution or locations. AT distribution influences a number of diseases. In EC, it remains unclear whether the type of AT distribution affects development or prognosis. This systematic review aimed to determine whether AT distribution is associated with patient characteristics, disease characteristics, and patient prognosis in EC.

Materials and methods

A search was conducted in Medline, MEDLINE EMBASE, and Cochrane Library. We included studies that enrolled patients with EC with any histological subtype and that distinguished between the visceral and subcutaneous AT compartment. In eligible studies, correlative analyses were performed for all outcome measures and AT distribution.

Results

Eleven retrospective studies were included, with a wide range of measurements for the visceral and subcutaneous AT compartments. AT distribution was found to be significantly correlated to a number of relevant (disease) characteristics including obesity measures, histological subtype, lymph node metastasis, and sex steroid levels. Five studies reported on survival parameters including overall survival, progression-free survival and disease-specific survival, and they found that increased VAT volume was statistically significantly associated with a worse survival.

Discussion/conclusion

This review demonstrates that there are significant correlations between AT distribution and prognosis, body mass index, sex steroid levels, and disease characteristics like histology. Well-designed, prospective, and larger-scale studies are needed to pinpoint these differences more specifically and understand how it can add in prediction and even therapy in EC.

Sarcobesity, but not visceral fat, is an independent risk factor for complications after radical resection of colorectal cancer

Background

The influence of body composition on the outcome of colorectal cancer surgery is controversial. The aim of this study was to evaluate the effects of visceral obesity and sarcobesity on the incidence of total and surgical complications after radical resection of colorectal cancer.

Methods

We collected a total of 426 patients who underwent elective radical resection of colorectal cancer at Beijing Friendship Hospital, Capital Medical University from January 2017 to May 2018. According to the inclusion and exclusion criteria, 387 patients were finally included. A CT scan at the level of the L3-L4 intervertebral disk was selected to measure the values of visceral fat area and skeletal muscle area. Multivariate analysis was used to explore the independent risk/protective factors affecting postoperative complications.

Results

128 (33.1%) patients developed complications, and 44 (11.4%) patients developed major complications. Among them, 111 patients developed surgical complications and 21 developed medical complications. Visceral fat area (Z = -3.271, p = 0.001), total fat area (Z = -2.613, p = 0.009), visceral fat area to subcutaneous fat area ratio (V/S, Z = -2.633, p = 0.008), and sarcobesity index (Z = -2.282, p = 0.023) were significantly associated with total complications. Visceral fat area (Z = -2.119, p = 0.034) and V/S (Z = -2.010, p = 0.044) were significantly associated with total surgical complications. Sarcobesity index, smoking, stoma, blood loss, surgery time, and American Society of Anesthesiology (ASA) score were selected as risk factors for total postoperative complications according to LASSO regression. Multivariate logistic regression analysis suggested that sarcobesity index was an independent risk factor for postoperative total complications and surgical complications. Subgroup analysis suggested that albumin level was an independent protective factor for postoperative total complications in male patients. Smoking, operative time, and sarcobesity index were independent risk factors, and cholesterol was an independent protective factor for total postoperative complications in female patients.

Conclusion

Increased sarcobesity index is an independent risk factor for postoperative complications in patients with colorectal cancer, while visceral fat area is not. For female patients, smoking, operation time, and obesity index are independent risk factors for postoperative complications, while cholesterol is an independent protective factor. For male patients, serum albumin is an independent protective factor for postoperative complications.

Associations of muscle and adipose tissue parameters with long-term outcomes in middle and low rectal cancer: a retrospective cohort study

OBJECTIVE

To investigate the role of preoperative body composition analysis for muscle and adipose tissue distribution on long-term oncological outcomes in patients with middle and low rectal cancer (RC) who received curative intent surgery.

METHODS

A total of 155 patients with middle and low rectal cancer who underwent curative intent surgery between January 2014 and December 2016 were included for the final analysis. Skeletal muscle area (SMA), skeletal muscle radiodensity (SMD), visceral fat area (VFA) and mesorectal fat area (MFA) were retrospectively measured using preoperative CT images. To standardize the area according to patient stature, SMA was divided by the square of the height (m²) and the skeletal muscle mass index (SMI, cm²/m²) was obtained. Each median values of the distribution in male and female served as cut-off point for SMI, SMD, VFA, and MFA, respectively. Univariate and multivariate analysis were performed to evaluate the association between body composition and long-term oncological outcomes. Overall survival (OS) measured in months from the day of primary surgery until death for any cause. Disease-free survival (DFS) was defined as the interval between surgery and tumor recurrence. The Kaplan-Meier method with log-rank testing was used to validate prognostic biomarkers. Intraclass correlation coefficient (ICC) was used to evaluate interobserver and intraobserver reproducibility for SMA, SMD, MFA,VFA.

RESULTS

During the follow-up period, 42 (27.1%) patients had tumor recurrence; 21 (13.5%) patients died. The sex-specific median value of SMI was 28.6 cm²/m² for females and 48.2 cm²/m² for males. The sex-specific median value of SMD was 34.7 HU for females and 37.4 HU for males. The sex-specific median value of VFA was 123.1 cm² for females and 123.2 cm² for males. The sex-specific median value of MFA was 13.8 cm² for females and 16.0 cm² for males. In the Cox regression multivariate analysis, SMI (P = 0.036), SMD (P = 0.022), and postoperative complications grades (P = 0.042) were significantly different between death group and non-death group; SMD (P = 0.011) and MFA (P = 0.022) were significantly different between recurrence group and non-recurrence group. VFA did not show any significant differences. By the Kaplan-Meier method with log-rank testing, DFS was significantly longer in patients with high-MFA (P = 0.028) and shorter in patients with low-SMD (P = 0.010), OS was significantly shorter in patients with low-SMI (P = 0.034) and low-SMD (P = 0.029).

CONCLUSIONS

Quantitative evaluation of skeletal muscle mass and adipose tissue distributions at initial diagnosis were important predictors for long-term oncologic outcomes in RC patients. SMD and SMI were independent factors for predicting OS in patients with middle and low rectal cancer who had radical surgery. SMD and MFA were independent factors for predicting DFS in patients with middle and low rectal cancer who had radical surgery.

The Sex and Race/Ethnicity-Specific Relationships of Abdominal Fat Distribution and Anthropometric Indices in US Adults

The purpose of this study was to examine demographic-specific relationships between direct abdominal fat measures and anthropometric indices. A cross-sectional study was conducted utilizing abdominal fat measures (visceral fat area, VFA; visceral to subcutaneous adipose area ratio, VSR) and anthropometrics (body mass index, BMI; waist circumference, WC) data from the 2011-2018 National Health and Nutrition Examination Survey. Linear or polynomial linear regression models were used to examine the relationships of abdominal fat measures to anthropometrics with adjustment for demographics. The results revealed that while VFA was linearly related to BMI and WC across all demographics (p < 0.001), the relationships between VSR and both BMI and WC were concave in men and convex in women. The relationships between VFA, VSR, and BMI, WC varied by sex and race/ethnicity. In conclusion, increasing BMI and WC were linearly associated with increased VFA, but their relationships with VSR were nonlinear and differed by sex.

Computed tomography-measured body composition and survival in rectal cancer patients: a Swedish cohort study

BACKGROUND

The association between body composition and survival in rectal cancer patients is still unclear. Therefore, we aimed to evaluate the impact of computed tomography (CT)-measured body composition on survival in rectal cancer patients, stratifying our analyses by sex, tumour location, tumour stage and radiotherapy.

METHODS

This retrospective cohort study included 173 patients with rectal adenocarcinoma. CT colonography scans at the time of diagnosis were used to assess the skeletal muscle index (SMI) and the visceral adipose tissue area (VAT). The patients were divided into a low or high SMI group and a low or high VAT group according to previously defined cutoff values. Endpoints included cancer-specific survival (CSS) and overall survival (OS).

RESULTS

In all patients, low SMI was associated with worse CSS (HR, 2.63; 95% CI, 1.35-5.12; P = 0.004) and OS (HR, 3.57; 95% CI, 2.01-6.34; P < 0.001) compared to high SMI. The differences remained significant after adjusting for potential confounders (CSS: adjusted HR, 2.28; 95% CI, 1.13-4.58; P = 0.021; OS: adjusted HR, 3.17; 95% CI, 1.73-5.82; P < 0.001). Low SMI was still related to a poor prognosis after stratifying by sex, tumour location, stage and radiotherapy (P < 0.05). High VAT was associated with better CSS (HR, 0.31; 95% CI, 0.11-0.84; P = 0.022) and OS (HR, 0.40; 95% CI, 0.17-0.97; P = 0.044) compared to low VAT among men with rectal cancer ≤ 10 cm from the anal verge. High VAT was associated with worse CSS (HR, 4.15; 95% CI, 1.10-15.66; P = 0.036) in women with rectal cancer ≤ 10 cm from the anal verge.

CONCLUSIONS

Low SMI was associated with worse survival. High VAT predicted better survival in men but worse survival in women. The results suggest that CT-measured body composition is a useful tool for evaluating the prognosis of rectal cancer patients and demonstrate the need to include the sex and the tumour location in the analyses.

Impact of obesity on morbidity and oncologic outcomes after total mesorectal excision for mid and low rectal cancer

BACKGROUND

A recent meta-analysis showed that obesity increased the conversion rate and postoperative morbidity of rectal cancer surgery, but did not influence pathological results. However, this meta-analysis included patients with cancer of the upper rectum and had many biases. The aim of the present retrospective study was to investigate the impact of obesity, defined as a body mass index (BMI) ≥ 30 kg/m², on postoperative morbidity and short- and long-term oncologic outcomes of total mesorectal excision for mid and low rectal cancer in consecutive patients.

METHODS

This study included all eligible patients who were operated on for mid and lower rectal cancer between 1999 and 2018 in our hospital. We compared 90-day postoperative morbidity and mortality, and short- and long-term oncologic outcomes between obese and non-obese patients.

RESULTS

Three hundred and ninety patients [280 males, mean age 65.7 ± 11.3 years, 59 obese individuals (15.1%)] were included. There was no difference in the 90-day mortality rate between obese and non-obese groups (p = 0.068). There was a difference in the overall 90-day morbidity rate between the obese and non-obese groups that disappeared after propensity score matching of the patients. There was no difference in short-term oncological parameters, with a median follow-up of 43 (20-84) months, and there were no significant differences in disease-free and overall survival between obese and non-obese patients (p = 0.42 and p = 0.11, respectively).

CONCLUSIONS

Obesity does not affect the 90-day morbidity rate, or short- and long-term oncologic results in patients operated on for mid and lower rectal cancer.

Obesity may not be related to pathologic response in locally advanced rectal cancer following neoadjuvant chemoradiotherapy

Background

The aim of this study is to evaluate the correlation between body mass index (BMI) and body fat composition (measured with radiological fat parameters (RFP)) and pathological response after neoadjuvant chemoradiotherapy for locally advanced rectal cancer patients. The secondary aim of the study was to assess the role of BMI and RFP on major surgical complications, overall survival (OS), and disease-free survival (DFS).

Methods

All patients who underwent surgical resection following nCRT between 2005 and 2017 for mid-low rectal cancer were retrospectively collected. Visceral fat area (VFA), superficial fat area (SFA), visceral/superficial fat area ratio (V/S), perinephric fat thickness (PNF), and waist circumference (WC) were estimated by baseline CT scan. Predictors of pathologic response and postoperative complications were investigated using logistic regression analysis. The correlations between BMI and radiologic fat parameters and survival were investigated using the Kaplan-Meier method and log-rank test.

Results

Out of 144 patients included, a complete (TRG1) and major (TRG1+2) pathologic response was reported in 32 (22%) and 60 (45.5%) cases, respectively. A statistically significant correlation between BMI and all the RFP was found. At a median follow-up of 60 (35-103) months, no differences in terms of OS and DFS were found considering BMI and radiologic fat parameters. At univariable analysis, neither BMI nor radiologic fat parameters were predictors of complete or major pathologic response; nevertheless, VFA, V/S>1, and BMI were predictors of postoperative major complications.

Conclusions

We found no associations between BMI and body fat composition and pathological response to nCRT, although VFA, V/S, and BMI were predictors of major complications. BMI and RFP are not related to worse long-term OS and DFS.

Relationship between BMI, CT-derived body composition and colorectal neoplasia in a bowel screening population

Introduction

Obesity is associated with an increased risk of colorectal cancer (CRC). Unlike the indirect measures such as BMI, CT-Body composition (CT-BC) allows for the assessment of both volume and distribution of adipose tissue. Therefore, the aim of this study was to examine the relationship between host characteristics, BMI, CT-BC measurements and the incidence of colorectal neoplasia.

Methods

Patients undergoing CT Colonography (CTC) as part of the Scottish Bowel Screening Programme, between July 2009 and February 2016, were eligible for inclusion. Data were collected including demographic data, clinicopathological variables and CT-BC measurements including skeletal muscle index (SMI), subcutaneous fat index (SFI) and visceral fat area (VFA). CTC, colonoscopy, and pathology reports were used to identify CRC incidence. Associations between demographic data, clinicopathological variables, CT-BC measurements, colorectal neoplasia and advanced colorectal neoplasia were analysed using univariate and multivariate binary logistics regression.

Results

286 patients met the inclusion criteria. Neoplasia was detected in 105 (37%) of the patients with advanced neoplasia being detected in 72 (69%) of patients. On multivariate analysis sex (p < 0.05) and high VFA (p < 0.001) remained independently associated with colorectal neoplasia. On multivariate analysis a high SFI (p < 0.01) remained independently associated with advanced colorectal neoplasia. BMI was not associated with either colorectal neoplasia or advanced colorectal neoplasia.

Conclusion

When directly compared to BMI, CT derived fat measurements were more closely associated with the degree of neoplasia in patients undergoing colorectal cancer screening. In patients investigated with CT colonography, CT adipose measures may stratify the risk and grade of neoplasia.

[Factors influencing the survival prognosis in older adults]

AIM

The present study examined the predictive factors for the survival prognosis in older adults.

METHODS

The subjects were 431 patients (75-99 years old) who visited our hospital between April 2016 and March 2019. Multivariate analyses were conducted to clarify the survival prognosis (P <0.05).

RESULTS

In a Cox regression analysis, the significant factors for the survival were the age (hazard ratio [HR] 1.050, 95% confidence interval [CI] 1.014-1.087), Charlson comorbidity index (CCI) (low vs. medium: HR 0.106, 95% CI 0.032-0.353; low vs. high: HR 0.244, 95% CI 0.150-0.398; low vs. very high: HR 0.514, 95% CI 0.326-0.809), pre-hospitalized gait (HR 1.861, 95% CI 1.158-2.988), sitting at discharge (HR 0.429, 95% CI 0.277-0.663), subcutaneous adipose tissue index (SATI) (HR 0.988, 95% CI 0.979-0.997) and modified controlling nutritional status (m-CONUT) (normal vs. light: HR 0.114, 95% CI 0.042-0.311; normal vs. moderate: HR 0.235, 95% CI 0.110-0.502; normal vs. severe: HR 0.351, 95% CI 0.166-0.741). In decision tree analyses, the significant factors for the 1-year survival were a CCI of low >medium >high-very high, body mass index of >20.7 kg/m², m-CONUT of normal-light >moderate-severe and sitting at discharge, and those for the 2-year survival were sitting at discharge, a SATI of >43.9 cm²m^-2, a CCI of low-medium >high-very high, male <female and m-CONUT of normal-light >moderate-severe.

CONCLUSIONS

High SATI and body mass index values appeared to be associated with better survival outcomes.

Visceral-to-Subcutaneous Fat Ratio Is a Potential Predictor of Postoperative Complications in Colorectal Cancer

Background

Colorectal cancer (CRC) is one of the most common malignant tumors. Surgery is the primary treatment for CRC. Recent studies have shown that visceral-to-subcutaneous fat ratio (VSR) may be a potential indicator of risk. The aim of the present study was to determine whether VSR is a suitable predictor of the impact of postoperative complications in CRC.

Material/Methods

Clinical data from 129 patients were analyzed retrospectively. All patients underwent laparoscopic surgery for CRC. Preoperative imaging was used to quantify VSR. The primary outcome was 30-day postoperative complications. Multivariate logistic regression was used to determine the association between obesity indexes and postoperative complications.

Results

There were 129 patients who underwent primary resections of colorectal cancer. At 30 days after surgery, postoperative complications had occurred in 33 (25.6%) patients. VSR was significantly associated with postoperative complications in multivariate analysis (P=0.032, OR 6.103, 95% CI 1.173–31.748). In ROC analysis, VSR was a potential predictor of complications (AUC 0.650). A cutoff value of VSR ≥0.707 was associated with 60% sensitivity and 29% specificity for postoperative complications. Patients with VSR ≥0.707 had 41.7% risk of morbidity, whereas those with <0.707 had 16.0% risk (P=0.001).

Conclusions

Our study shows that VSR is superior to VFA for prediction of the risk of complications following CRC laparoscopic surgery. We have also identified the optimal cutoff values for the use of VSR for this purpose. Measurement of VSR and identifying patients with increased risk of postoperative complications facilitate making perioperative decisions.

Can the mesorectal fat tissue volume be used as a predictive factor in foreseeing the response to neoadjuvant chemoradiotherapy in rectum cancer? A CT-based preliminary study

PURPOSE

This study was to investigate the effect of mesorectal fat tissue volume (MRV) on the pathological response to neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer.

METHODS

88 patients who had been diagnosed with locally advanced rectal cancer between January 2017 and June 2020 were reviewed retrospectively. The total abdominal, subcutaneous, visceral, and mesorectal fatty tissue components were measured semiquantitatively by two radiologists using computed tomography (CT)-based findings. The patients were divided into two groups as those with and without a pathological response to nCRT. The relationship of MRV with the other fat tissue components of the body was also evaluated.

RESULTS

We performed a retrospective analysis of 88 patients (mean age 62.7 years [range, 33-90 years]; 31 males and 57 females). A positive response to nCRT was present in 47 patients. There were 59 patients with stage 3 disease. 46 patients demonstrated lymph node involvement. The mean MRV was 69.6 ± 31.0 ml in no-response group and 105.8 ± 47.5 ml in response-positive patients (p < 0.05). MRV showed the highest correlation with visceral fat volume (VFV). There was a negative correlation between the MRV and the N stage. A cut-off value of ≥ 69.4 for MRV predicted the repsonse to nCRT, with 82.9% sensitivity and 58.5% specificity [AUC: 0.757 (0.653-0.842), p < 0.001] in receiver operating characteristic (ROC) curve analysis CONCLUSIONS: MRV can be used as a novel parameter in predicting of pathological response to nCRT in locally advanced rectal cancer patients.

Three different computed tomography obesity indices, two standard methods, and one novel measurement, and their association with outcomes after colorectal cancer surgery

BACKGROUND

Obesity can be measured by different indices, either as body mass index (BMI) or by more intuitive radiological measurements, and obesity has been shown to have an impact on outcome after colorectal cancer (CRC) surgery.

PURPOSE

To investigate whether the thickness of the subcutaneous adipose tissue (SAT) in the abdominal wall can be used as a surrogate for the visceral fat area (VFA)-both measured on computed tomography (CT)-in prediction of short- and long-term outcomes after elective CRC surgery.

MATERIAL AND METHODS

Preoperative CT scans of all patients having elective CRC surgery (stages I-III), in two consecutive years at a single-center institution, were used to measure the SAT (mm) and VFA (cm²). BMI was calculated for each patient. The three different obesity indices were used in different analyses in order to predict postoperative complications and overall survival.

RESULTS

A BMI >30 kg/m² was an independent prognostic factor in postoperative complications (odds ratio 3.2, 95% confidence interval [CI] 1.43-7.03). SAT and VFA were not able to predict complications. Patients considered visceral obese according to a high VFA (>130 cm²) had poorer survival (hazard ratio 1.53, 95% CI 1.00-2.36) compared to non-obese patients, but in the adjusted model, VFA lost its predictive power. BMI and SAT were not able to predict mortality.

CONCLUSION

The novel measurement of the thickness of SAT in a preoperative setting before elective CRC surgery cannot predict either postoperative complications or overall survival; the other obesity indices had better predictive features.

Combined Effects of Dyslipidemia and High Adiposity on the Estimated Glomerular Filtration Rate in a Middle-Aged Chinese Population

BACKGROUND

Some studies have reported that chronic kidney disease (CKD) or the estimated glomerular filtration rate (eGFR) is significantly associated with metabolic abnormalities.

METHODS

Six hundred forty-six community residents aged 45-60 years without overt renal dysfunction were recruited in this cross-sectional study. eGFR was estimated by serum creatinine measurement. The visceral fat area (VFA) and subcutaneous fat area (SFA) were assessed by magnetic resonance imaging (MRI). The body mass index (BMI) and waist-hip ratio (WHR) were also evaluated. Additionally, we tested the subjects' blood lipid levels to diagnose dyslipidemia.

RESULTS

Compared with the subjects with neither dyslipidemia nor obesity, men with both dyslipidemia and high obesity indices, such as BMI, WHR and VFA, showed a significantly lower mean eGFR; women with dyslipidemia with high WHR, VFA or SFA also showed a significantly lower mean eGFR. Although an independent association between the metabolic variables and eGFR was not found except for BMI, some of the combined effects of each variable were related to eGFR decline. Comorbidity of dyslipidemia and high WHR was significant risk factor for eGFR reduction (β -8.805, SD 4.116, p < 0.05). Additionally, comorbidity of dyslipidemia and high obesity indices such as BMI (β -12.942, SD 5.268, p < 0.05) and VFA (β -7.069, SD 3.394, p < 0.05) were significant risk factors for eGFR reduction in men.

CONCLUSION

The combined effect of dyslipidemia and high obesity indices is significantly related to the decline in eGFR. The association is more profound in men.

Clinical Value of Multi-Slice Spiral CT Angiography, Colon Imaging, and Image Fusion in the Preoperative Evaluation of Laparoscopic Complete Mesocolic Excision for Right Colon Cancer: a Prospective Randomized Trial

PURPOSE

To evaluate the clinical value of CT angiography (CTA), CT colonography (CTC), and image fusion in the preoperative evaluation of laparoscopic complete mesocolic excision (CME) for right colon cancer.

METHODS

In this randomized prospective study, 80 patients undergoing laparoscopic CME for right colon cancer were randomly divided into two groups: image fusion [the original images were reconstructed using CTA and CTC, then fused into three-dimensional images of the blood vessels and intestines (n = 40)] and control (without CTA and CTC reconstruction before surgery). All patients underwent plain and enhanced abdominal CT before surgery.

RESULTS

In the image fusion group, the gastrocolic trunk of Henle was present in 33 cases, and its branches originated from the colon vein, right gastroepiploic vein, and superior anterior pancreaticoduodenal vein. Among these patients, 5 exhibited the right gastroepiploic vein and superior anterior pancreaticoduodenal vein; 21 exhibited a gastrointestinal trunk consisting of 2 or 3 branches of the right gastroepiploic vein, right colon vein, and middle colon vein; and 7 exhibited 3 or 4 gastro-pancreatic and colon trunks consisting of the right colon vein, middle colon vein, right gastroepiploic vein, and superior anterior pancreaticoduodenal vein. The correspondence with the anatomy actually observed during surgery was 100%. Compared with the conventional CT group, the duration of the operation in the image fusion group was shorter, with reduced intraoperative bleeding, and more lymph node dissection. There were no significant differences in the incidence of complications and length of hospital stay between the two groups (p > 0.05).

CONCLUSIONS

For laparoscopic CME for right colon cancer, CTA, CTC, and image fusion were effective preoperative evaluation methods, which avoided some unseen dangers in the operation process and led to better therapeutic outcomes.

BMI May Be a Prognostic Factor for Local Advanced Rectal Cancer Patients Treated with Long-Term Neoadjuvant Chemoradiotherapy

OBJECTIVE

This study aims to develop feasible nomograms to predict the overall survival (OS) and cancer-specific survival (CSS) of the local advanced rectal cancer (LARC) patients who were treated with neoadjuvant chemoradiotherapy (nCRT) and operation.

METHODS

A total of 243 LARC patients undergoing nCRT followed by total mesorectal excision (TME) were enrolled. Preoperative clinical features and postoperative pathological characteristics were collected. A Cox regression analysis was performed, and Cox-based nomograms were developed to predict the OS and CSS. We assessed the predictive performance of the nomogram with concordance index and calibration plots.

RESULTS

A total of 243 patients were included with a median follow-up period of 46 months (range from 9 to 86 months). Cox regression analysis showed that low BMI (BMI < 18.5, HR= 21.739, P < 0.05), high level of preoperative CA19-9 (HR = 3.369, P = 0.036), high ypStage (HR = 19.768, P < 0.001), positive neural invasion (HR = 4.218, P = 0.026) and no adjuvant chemotherapy (HR = 5.495, P < 0.001) were independent predictors of poor OS. Age ≥70 (HR = 2.284, P <0.001), low BMI (BMI < 18.5, HR = 3.906, P < 0.05), positive preoperative CA19-9 (HR = 1.920, P = 0.012), high ypStage (HR = 5.147, P <0.001) and positive neural invasion (HR = 2.873, P = 0.022) were independent predictors of poor CSS. The predictive nomograms were developed to predict the OS and CSS with a C-index of 0.837 and 0.760. Good statistical performance on internal validation was shown by calibration plots.

CONCLUSION

In conclusion, this study demonstrated that BMI was an independent prognostic factor for OS and CSS in LARC patients treated with nCRT followed TME. A nomogram incorporating BMI, neural invasion, pre-CA19-9, ypStage, age, and adjuvant chemotherapy could be helpful to predict the OS and CSS.

Association of subcutaneous and visceral adipose tissue with overall survival in Taiwanese patients with bone metastases - results from a retrospective analysis of consecutively collected data

BACKGROUND

Growing evidence indicates that measures of body composition may be related to clinical outcomes in patients with malignancies. The aim of this study was to investigate whether measures of regional adiposity-including subcutaneous adipose tissue index (SATI) and visceral adipose tissue index (VATI)-can be associated with overall survival (OS) in Taiwanese patients with bone metastases.

METHODS

This is a retrospective analysis of prospectively collected data. We examined 1280 patients with bone metastases who had undergone radiotherapy (RT) between March 2005 and August 2013. Body composition (SATI, VATI, and muscle index) was assessed by computed tomography at the third lumbar vertebra and normalized for patient height. Patients were divided into low- and high-adiposity groups (for both SATI and VATI) according to sex-specific median values.

RESULTS

Both SATI (hazard ratio [HR]: 0.696; P<0.001) and VATI (HR: 0.87; P = 0.037)-but not muscle index-were independently associated with a more favorable OS, with the former showing a stronger relationship. The most favorable OS was observed in women with high SATI (11.21 months; 95% confidence interval: 9.434-12.988; P<0.001).

CONCLUSIONS

High SATI and VATI are associated with a more favorable OS in Taiwanese patients with bone metastases referred for RT. The question as to whether clinical measures aimed at improving adiposity may improve OS in this clinical population deserves further scrutiny.

Low psoas muscle index is a poor prognostic factor for lower gastrointestinal perforation: a single-center retrospective cohort study

Background

Various body composition indices have been reported as prognostic factors for different cancers. However, whether body composition affects prognosis after lower gastrointestinal tract perforation requiring emergency surgery and multidisciplinary treatment has not been clarified. This study examined whether body composition evaluations that can be measured easily and quickly from computed tomography (CT) are useful for predicting prognosis.

Methods

Subjects comprised 64 patients diagnosed with perforation at final diagnosis after emergency surgery for a preoperative diagnosis of lower gastrointestinal tract perforation and penetration. They were divided into a survival group and a non-survival (in-hospital mortality) group and compared. Body composition indices (psoas muscle index (PMI); psoas muscle attenuation (PMA); subcutaneous adipose tissue index (SATI); visceral adipose tissue index (VATI); visceral-to-subcutaneous fat area ratio (VSR)) were measured from preoperative CT. Cross-sectional psoas muscle area at the level of the 3rd lumbar vertebra was quantified. Optimal cut-off values were calculated using receiver operating characteristic curve analysis. Poor prognostic factors were investigated from multivariate logistic regression analyses that included patient factors, perioperative factors, intraoperative factors, and body composition indices as explanatory variables.

Results

The cause of perforation was malignant disease in 12 cases (18.7%), and benign disease in 52 cases (81.2%). The most common cause was diverticulum of the large intestine. Emergency surgery for the 64 patients led to survival in 52 patients and death in 12 patients. On multivariate logistic regression analysis, independent predictors of poor prognosis were Sequential Organ Failure Assessment score (odds ratio 1.908; 95% confidence interval (CI) 1.235–3.681; P = 0.0020) and PMI (odds ratio 13.478; 95%CI 1.342–332.690; P = 0.0252). The cut-off PMI was 4.75 cm²/m² for males and 2.89 cm²/m² for females. Among survivors, duration of hospitalization was significantly longer in the low PMI group (29 days) than in the high PMI group (22 days, p = 0.0257).

Conclusions

PMI is easily determined from CT and allows rapid evaluation of prognosis following lower gastrointestinal perforation.

The intricate relationship between diabetes, obesity and pancreatic cancer

Pancreatic cancer is one of the leading determinants of global cancer mortality, and its incidence is predicted to increase, to become in 2030 the second most common cause of cancer-related death. Obesity and diabetes are recognized risk factors for the development of pancreatic cancer. In the last few decades an epidemic of diabetes and obesity has been spreading worldwide, forewarning an increase in incidence of pancreatic cancer. This review considers the most recent literature, covering the multiple molecular axis linking these three pathologies, aiming to draw a more comprehensive view of pancreatic cancer for a better theragnostic stratification of the population.