Sarcopenia as a Risk Factor of Morbimortality in Colorectal Cancer Surgery
Abstract
:1. Introduction
2. Results
2.1. Relationship between Sarcopenia and the Clinical Pathological Data
2.2. Relation between Sarcopenia and Surgical Outcomes
2.3. Relation between Sarcopenia and Overall Survival
2.4. Relationship between Sarcopenia and Disease-Free Survival
3. Discussion
4. Materials and Methods
4.1. Patients
4.2. Data Collection
4.3. Image Analysis
4.4. Statistical Analysis
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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All Patients (n = 272) | Sarcopenic (n = 52) | Non-Sarcopenic (n = 220) | Statistics Test | |
---|---|---|---|---|
Age, Mdn (IQR) | 72.0 (17.0) | 71.0 (18.0) | 72.0 (16.0) | U = 5460, p = 0.609, r = −0.031 |
Gender, n (%) | ||||
Male | 167 (61.4) | 46 (88.5) | 121 (55.0) | χ2 (1) = 19.9, p < 0.001 *, Φ = −0.27 |
Female | 105 (38.6) | 6 (11.5) | 99 (45.0) | |
CRC family historya, n (%) | ||||
Absent | 237 (92.6) | 48 (100.0) | 189 (90.9) | Fisher’s test, p = 0.029 *, Φ = −0.14 |
Present | 19 (7.40) | 0 (0.00) | 19 (9.10) | |
Clinical presentation, n (%) | ||||
Asymptomatic | 48 (17.6) | 6 (11.5) | 42 (19.1) | χ2 (1) = 1.65, p = 0.230, Φ = 0.078 |
Symptomatic | 224 (82.4) | 46 (88.5) | 178 (80.9) | |
Tumour site, n (%) | ||||
Colon | 193 (71.9) | 44 (84.6) | 149 (67.7) | χ2 (1) = 5.82, p = 0.017, Φ = −0.15 |
Rectum | 79 (29.0) | 8 (15.4) | 71 (32.3) | |
Macroscopic aspecta, n (%) | ||||
Polypoid | 135 (53.6) | 24 (52.2) | 111 (53.9) | Fisher’s test, p = 0.085, Φc = 0.19 |
Ulcerative | 66 (26.2) | 9 (19.6) | 57 (27.7) | |
Infiltrative | 24 (9.50) | 3 (6.50) | 21 (10.2) | |
Exophytic | 26 (10.30) | 10 (21.7) | 16 (7.80) | |
Villous | 1 (0.40) | 0 (0.00) | 1 (0.50) | |
Measurementa, n (%) | ||||
≤45 mm | 167 (64.5) | 27 (56.3) | 140 (66.4) | χ2 (1) = 1.74, p = 0.242, Φ = 0.082 |
>45 mm | 92 (35.5) | 21 (43.8) | 71 (33.6) | |
Histological type, n (%) | ||||
Adenocarcinoma | 245 (90.1) | 48 (92.3) | 197 (89.5) | Fisher’s test, p = 0.834, Φc = 0.043 |
Mucinous | 26 (9.60) | 4 (7.70) | 22 (10.0) | |
Signet ring cells | 1 (0.40) | 0 (0.00) | 1 (0.50) | |
Differentiationa, n (%) | ||||
Well differentiated | 125 (47.9) | 22 (45.8) | 103 (48.4) | Fisher’s test, p = 0.959, Φc = 0.038 |
Moderately differentiated | 102 (39.1) | 20 (41.7) | 82 (38.5) | |
Poorly differentiated | 33 (12.6) | 6 (12.5) | 27 (12.7) | |
Undifferentiated | 1 (0.40) | 0 (0.00) | 1 (0.50) | |
Venous invasiona, n (%) | ||||
Absent | 146 (57.5) | 28 (59.6) | 118 (57.0) | χ2 (1) = 0.009, p = 0.870, Φ = -0.020 |
Present | 108 (42.5) | 19 (40.4) | 89 (43.0) | |
Lymphatic invasiona, n (%) | ||||
Absent | 103 (41.0) | 19 (40.4) | 84 (41.2) | χ2 (1) = 0.01, p = 1.000, Φ = 0.006 |
Present | 148 (59.0) | 28 (59.6) | 120 (58.8) | |
Stagea, n (%) | ||||
I | 43 (16.2) | 7 (14.0) | 36 (16.7) | χ2 (3) = 0.93, p = 0.817, Φc = 0.059 |
II | 87 (32.7) | 17 (34.0) | 70 (32.4) | |
III | 93 (35.0) | 16 (32.0) | 77 (35.6) | |
IV | 43 (16.2) | 10 (20.0) | 33 (15.3) | |
CEAa, n (%) | ||||
≤10 ng/mL | 197 (82.4) | 35 (77.8) | 162 (83.5) | χ2 (1) = 0.83, p = 0.386, Φ = 0.059 |
>10 ng/mL | 42 (17.6) | 10 (22.2) | 32 (16.5) |
All Patients | Sarcopenic | Non-Sarcopenic | Statistics Test | |
---|---|---|---|---|
Total abdominal muscle area, L3 (cm2), Mdn (IQR) | 142 (47.0) | 131 (24.9) | 149 (51.2) | U = 3525, p < 0.001 *, r = −0.26 |
Skeletal muscle index (SMI) (cm2/m2), Mdn (IQR) | 53.7 (12.5) | 48.2 (8.50) | 56.2 (12.6) | U = 1955, p < 0.001 *, r = −0.45 |
All Patients (n = 272) | Sarcopenic (n = 52) | Non-Sarcopenic (n = 220) | Statistics Test | |
---|---|---|---|---|
Morbimortalitya, n (%) | ||||
Absent | 176 (65.3) | 34 (66.7) | 141 (65.0) | χ2 (1) = 0.052, p = 0.871, Φ = −0.014 |
Present | 92 (34.7) | 17 (33.3) | 76 (35.0) | |
Surgical site infectiona, n (%) | ||||
Absent | 235 (87.7) | 45 (88.2) | 190 (87.6) | χ2 (1) = 0.018, p = 1.000, Φ = −0.008 |
Present | 33 (12.3) | 6 (11.8) | 27 (12.4) | |
Anastomosis leakagea, n (%) | ||||
Absent | 246 (91.8) | 45 (88.2) | 201 (92.6) | Fisher’s test, p = 0.392, Φ = 0.063 |
Present | 22 (8.20) | 6 (11.8) | 16 (7.40) | |
Intraabdominal abscessa, n (%) | ||||
Absent | 255 (95.1) | 48 (94.1) | 207 (95.4) | Fisher’s test, p = 0.718, Φ = 0.023 |
Present | 13 (4.90) | 3 (5.90) | 10 (4.60) | |
Other infectionsa,b, n (%) | ||||
Absent | 261 (97.4) | 51 (100.0) | 210 (96.8) | Fisher’s test, p = 0.353, Φ = −0.079 |
Present | 7 (2.60) | 0 (0.00) | 7 (3.20) | |
Pulmonary complicationsa, n (%) | ||||
Absent | 254 (94.8) | 48 (94.1) | 206 (94.9) | Fisher’s test, p = 0.734, Φ = 0.014 |
Present | 14 (5.20) | 3 (5.90) | 11 (5.10) | |
Other complicationsa,c, n (%) | ||||
Absent | 248 (92.5) | 48 (94.1) | 200 (92.2) | Fisher’s test, p = 0.774, Φ = −0.029 |
Present | 20 (7.50) | 3 (5.90) | 17 (7.80) | |
Clavien-Dindo classification, n (%) | ||||
Grade I | 27 (29.3) | 2 (11.8) | 25 (33.3) | Fisher’s test, p = 0.003 *, Φc = 0.44 |
Grade II | 28 (30.4) | 2 (11.8) | 26 (34.7) | |
Grade IIIb | 21 (22.8) | 7 (41.2) | 14 (18.7) | |
Grade Iva | 1 (1.10) | 1 (5.90) | 0 (0.00) | |
Grade IVb | 1 (1.10) | 1 (5.90) | 0 (0.00) | |
Grade V | 14 (15.2) | 4 (23.5) | 10 (13.3) | |
≥ Grade II, n (%) | ||||
Absent | 26 (28.3) | 2 (11.8) | 24 (32.0) | Fisher’s test, p = 0.137, Φ = 0.17 |
Present | 66 (71.7) | 15 (88.2) | 51 (68.0) | |
≥ Grade III, n (%) | ||||
Absent | 54 (58.7) | 4 (23.5) | 50 (66.7) | χ2 (1) = 10.6, p = 0.002 *, Φ = 0.34 |
Present | 38 (41.3) | 13 (76.5) | 25 (33.3) |
Univariate Analysis | Multivariate Analysis * | |||
---|---|---|---|---|
Unadjusted OR (CI 95%) | p Value | Adjusted OR (CI 95%) | p Value | |
Age | 1.02 (0.98, 1.07) | 0.328 | 1.04 (0.98, 1.11) | 0.155 |
Gender (male vs. female) | 0.66 (0.26, 1.64) | 0.369 | 1.30 (0.35, 4.90) | 0.685 |
Tumour site (colon vs. rectum) | 0.85 (0.36, 1.99) | 0.706 | ||
Stage (I, II vs. III, IV) | 0.87 (0.38, 2.01) | 0.747 | ||
Total abdominal muscle area | 0.99 (0.98, 1.01) | 0.272 | ||
Sarcopenia (absent vs. present) | 6.50 (1.92, 22.0) | 0.003 | 13.6 (2.42, 76.7) | 0.003 * |
Anastomosis leakage (absent vs. present) | 28.9 (6.14, 136) | <0.001 | 42.9 (6.75, 272) | <0.001 * |
Intraabdominal abscess (absent vs. present) | 2.61 (0.78, 8.73) | 0.119 | 5.42 (1.16, 25.3) | 0.031 * |
Surgical site infection (absent vs. present) | 0.39 (0.16, 0.97) | 0.044 | 0.76 (0.19, 3.04) | 0.700 |
Other infections (absent vs. present) | 0.27 (0.030, 2.36) | 0.234 | ||
Pulmonary complications (absent vs. present) | 0.34 (0.087, 1.30) | 0.113 | 0.44 (0.071, 2.69) | 0.371 |
All Patients (n = 272) | Sarcopenic (n = 52) | Non-Sarcopenic (n = 220) | Statistics Test | |
---|---|---|---|---|
Postoperative hospital stay (days), Mdn (IQR) | 7.00 (4.00) | 7.00 (4.00) | 7.00 (4.00) | U = 5589, p = 0.915, r = 0.007 |
Readmission, n (%) | ||||
Absent | 265 (97.4) | 50 (96.2) | 215 (97.7) | Fisher’s test, p = 0.622, Φ = 0.039 |
Present | 7 (2.60) | 2 (3.80) | 5 (2.30) | |
30-day mortalitya, n (%) | ||||
Absent | 251 (92.6) | 46 (88.5) | 205 (93.6) | Fisher’s test, p = 0.235, Φ = 0.078 |
Present | 20 (7.40) | 6 (11.5) | 14 (6.40) |
Univariate Analysis | Multivariate Analysis | |||
---|---|---|---|---|
Unadjusted HR (CI 95%) | p Value | Adjusted HR (CI 95%) | p | |
Age | 1.00 (0.98, 1.02) | 0.941 | 1.02 (1.00. 1.05) | 0.118 |
Gender (male vs. female) | 0.94 (0.59, 1.52) | 0.813 | 1.11 (0.61. 2.02) | 0.733 |
CRC family history (absent vs. present) | 0.48 (0.15, 1.52) | 0.211 | ||
Tumour site (colon vs. rectum) | 1.03 (0.63, 1.70) | 0.899 | ||
Stage (I, II vs. III, IV) | 2.33 (1.45, 3.24) | <0.001 | 1.21 (0.60. 2.45) | 0.599 |
Total abdominal muscle area | 1.00 (1.00, 1.00) | 0.357 | ||
Sarcopenia (absent vs. present) | 1.65 (0.98, 2.78) | 0.058 | 1.83 (0.96. 3.49) | 0.066 |
Differentiation (G1, G2 vs. G3, G4) | 1.53 (0.78, 2.97) | 0.215 | ||
Venous invasion (absent vs. present) | 2.81 (1.75, 4.50) | <0.001 | 3.05 (1.64. 5.66) | <0.001 * |
Lymphatic invasion (absent vs. present) | 1.69 (1.03, 2.77) | 0.036 | 0.95 (0.46. 1.97) | 0.887 |
CEA (≤10 versus >10 ng/mL) | 2.86 (1.63, 5.03) | <0.001 | 3.21 (1.69, 6.09) | <0.001 * |
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Pereira, M.; Pereira, A.; Silva, P.; Costa, C.; Martins, S.F. Sarcopenia as a Risk Factor of Morbimortality in Colorectal Cancer Surgery. Gastrointest. Disord. 2020, 2, 107-117. https://doi.org/10.3390/gidisord2020010
Pereira M, Pereira A, Silva P, Costa C, Martins SF. Sarcopenia as a Risk Factor of Morbimortality in Colorectal Cancer Surgery. Gastrointestinal Disorders. 2020; 2(2):107-117. https://doi.org/10.3390/gidisord2020010
Chicago/Turabian StylePereira, Mariana, Ana Pereira, Patrícia Silva, Catarina Costa, and Sandra F. Martins. 2020. "Sarcopenia as a Risk Factor of Morbimortality in Colorectal Cancer Surgery" Gastrointestinal Disorders 2, no. 2: 107-117. https://doi.org/10.3390/gidisord2020010