Prognostic significance of osteopenia in patients with colorectal cancer: A retrospective cohort study
Teppei Kamada, Kenei Furukawa, Junji Takahashi, Keigo Nakashima, Yuichi Nakaseko, Norihiko Suzuki, Masashi Yoshida, Hironori Ohdaira, Toru Ikegami, Yutaka Suzuki
Abstract
Abstract Aim We examined the prognostic impact of osteopenia on the long‐term outcomes of patients with colorectal cancer after laparoscopic colectomy along with other nutritional factors, including sarcopenia or the Glasgow Prognostic Score. Methods This retrospective cohort study analyzed the data of 230 patients with stage Ⅰ–Ⅲ colorectal cancers who underwent surgical resection between November 2010 and December 2015. Osteopenia and sarcopenia were evaluated by measuring the average pixel density in the mid‐vertebral core of the 11th thoracic vertebra on enhanced computed tomography and the psoas muscle mass area at the third lumbar vertebra, respectively. The overall survival and disease‐free survival rates were analyzed using Cox proportional hazards model and Kaplan–Meier curves with the log‐rank test. Results Osteopenia was identified in 43 patients (18.7%). Univariate analysis showed that the disease‐free survival rate was significantly worse in patients with stage II–III cancers, vascular invasion, carcinoembryonic antigen (CA) >5.0 ng/mL, CA19‐9 > 37.0 U/mL, sarcopenia, and osteopenia (all P < .01). Multivariate analysis revealed that stage II–III cancers ( P = .01), vascular invasion ( P = .01), carcinoembryonic antigen >5.0 ( P < .01), and osteopenia ( P < .01) were significant independent disease‐free survival predictors. In univariate analysis, the overall survival rate significantly decreased in patients with stage II–III cancers ( P = .03), carcinoembryonic antigen >5.0 ( P < .01), CA19‐9 > 37.0 ( P < .01), sarcopenia ( P < .01), and osteopenia ( P < .01). Multivariate analysis indicated that carcinoembryonic antigen >5.0 ( P = .04), CA19‐9 > 37.0 ( P = .05), and osteopenia ( P < .01) were significant independent predictors of overall survival. Conclusion Preoperative osteopenia could be a strong predictor of long‐term outcomes in patients undergoing resection for colorectal cancer.