Huang Weiyan, Feng Zhichao, Ma Mengtian, Song Fulong, Zeng Shumin, Shao Fang, Yu Xiaoping, Rong Pengfei, Chen Jianqiang
Department of Radiology, The First Affiliated Hospital of Hainan Medical University, Haikou, China.
Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China.
Front Oncol. 2024 Aug 1;14:1421651. doi: 10.3389/fonc.2024.1421651. eCollection 2024.
Body composition is recognized to be associated with clinical outcomes in patients with locally advanced rectal cancer (LARC). This study aimed to determine the prognostic role of regional adipose tissue distribution in patients with resectable LARC treated with or without neoadjuvant chemoradiotherapy (nCRT).
This retrospective study included 281 consecutive patients who underwent radical surgery for LARC with or without preoperative nCRT between 2013 and 2019. Patients underwent contrast-enhanced CT scans before nCRT and before surgery. Visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (aSAT), and gluteal subcutaneous adipose tissue (gSAT) were quantified on the CT images. The association of adipose tissue distribution with progression-free survival (PFS) was analyzed using Cox proportional hazards analysis.
A total of 102 nCRT-treated and 179 primarily resected patients were included. During a median follow-up period of 24 months, 74 (26.3%) patients experienced local recurrence or metastasis. Multivariable analysis showed that VAT was associated with PFS in all patients (hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.04-1.57; = 0.021). This association was only maintained in primarily resected patients (HR 1.31, 95% CI 1.02-1.69; = 0.037). For patients receiving preoperative nCRT, VAT was not significantly associated with PFS, while the dynamic change in gSAT (ΔgSAT) between nCRT and surgery was associated with PFS (HR 0.43, 95%CI 0.27-0.69, = 0.001).
Visceral obesity is an adverse prognostic factor in patients with resectable LARC treated by primary resection, while increased gluteal subcutaneous adiposity during preoperative nCRT may indicate favorable clinical outcomes.
身体组成被认为与局部晚期直肠癌（LARC）患者的临床结局相关。本研究旨在确定区域脂肪组织分布在接受或未接受新辅助放化疗（nCRT）的可切除LARC患者中的预后作用。
这项回顾性研究纳入了2013年至2019年间连续281例接受LARC根治性手术的患者，这些患者接受或未接受术前nCRT。患者在nCRT前和手术前接受了增强CT扫描。在CT图像上对内脏脂肪组织（VAT）、腹部皮下脂肪组织（aSAT）和臀皮下脂肪组织（gSAT）进行定量分析。使用Cox比例风险分析来分析脂肪组织分布与无进展生存期（PFS）之间的关联。
总共纳入了102例接受nCRT治疗的患者和179例直接接受手术切除的患者。在中位随访期24个月期间，74例（26.3%）患者出现局部复发或转移。多变量分析显示，VAT与所有患者的PFS相关（风险比[HR]1.28，95%置信区间[CI]1.04 - 1.57；P = 0.021）。这种关联仅在直接接受手术切除的患者中存在（HR 1.31，95%CI 1.02 - 1.69；P = 0.037）。对于接受术前nCRT的患者，VAT与PFS无显著关联，而nCRT与手术之间gSAT的动态变化（ΔgSAT）与PFS相关（HR 0.43，95%CI 0.27 - 0.69，P = 0.001）。
内脏肥胖是直接手术切除治疗的可切除LARC患者的不良预后因素，而术前nCRT期间臀皮下脂肪增多可能预示着良好的临床结局。
