Jeong Hyehyun, Ko Yousun, Kim Kyung Won, Lee Ji Sung, Seo Seyoung, Kim Sun Young, Hong Yong Sang, Kim Jeong Eun, Kim Tae Won
Department of Oncology, Asan Medical Center, Seoul 05505, South Korea.
Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul 05505, South Korea.
World J Gastrointest Oncol. 2025 May 15;17(5):103479. doi: 10.4251/wjgo.v17.i5.103479.
In patients with metastatic colorectal cancer, chemotherapy may lead to changes in body composition, including skeletal muscle quantity and quality, and body fat area and distribution. Longitudinal follow-up data in a homogeneous population are required to understand these changes better.
To comprehensively evaluate changes in body composition and their prognostic value in patients with metastatic colorectal cancer undergoing palliative chemotherapy.
This retrospective study included patients with recurrent or metastatic colorectal cancer who received palliative chemotherapy between 2008 and 2017. Computed tomography scans were analyzed at multiple time points (before each new chemotherapy regimen and after discontinuing all chemotherapy). Body composition was analyzed from each scan using artificial intelligence software (AID-UTM, iAID Inc.), and its association with survival was evaluated through time-dependent Cox regression to adjust for time-varying effects.
This analysis included 1805 patients, with a median age at diagnosis of 57 years, and 62% were male. At first-line chemotherapy initiation, 4.7%, 30.9%, 36.5%, and 37.1% of the patients had sarcopenia, myosteatosis, and visceral and subcutaneous obesity, respectively. During treatment, approximately 54.5% of the patients experienced significant changes in body composition, with 9.1% and 19.2% developing new sarcopenia and myosteatosis, respectively. Sarcopenia and myosteatosis were associated with poorer survival outcomes [hazard ratio (HR) for sarcopenia, 2.55 (95%CI: 2.06-3.16, < 0.001; HR for myosteatosis, 2.37 (95%CI: 2.00-2.82), < 0.001]. In contrast, visceral and subcutaneous obesity were associated with improved survival [HR for visceral obesity, 0.69 (95%CI: 0.57-0.82), < 0.001; HR for subcutaneous obesity, 0.78 (95%CI: 0.64-0.95), = 0.015], with no negative impacts observed at higher fat levels. These changes correlated with end-of-life survival time.
Abnormalities and body composition changes were frequently observed during palliative chemotherapy for advanced colorectal cancer; myosteatosis was common. Comprehensive body composition assessment offers valuable prognostic insights without requiring additional testing.
在转移性结直肠癌患者中，化疗可能导致身体成分发生变化，包括骨骼肌的数量和质量、体脂面积和分布。需要在同质人群中进行纵向随访数据，以更好地了解这些变化。
全面评估接受姑息化疗的转移性结直肠癌患者身体成分的变化及其预后价值。
这项回顾性研究纳入了2008年至2017年间接受姑息化疗的复发性或转移性结直肠癌患者。在多个时间点（每次新化疗方案前和停止所有化疗后）分析计算机断层扫描。使用人工智能软件（AID-UTM，iAID公司）对每次扫描的身体成分进行分析，并通过时间依赖性Cox回归评估其与生存的关联，以调整时间变化效应。
该分析纳入了1805例患者，诊断时的中位年龄为57岁，62%为男性。在一线化疗开始时，分别有4.7%、30.9%、36.5%和37.1%的患者患有肌肉减少症、肌少脂性肥胖、内脏肥胖和皮下肥胖。在治疗期间，约54.5%的患者身体成分发生了显著变化，分别有9.1%和19.2%的患者出现了新的肌肉减少症和肌少脂性肥胖。肌肉减少症和肌少脂性肥胖与较差的生存结果相关[肌肉减少症的风险比（HR）为2.55（95%CI：2.06-3.16，<0.001）；肌少脂性肥胖的HR为2.37（95%CI：2.00-2.82），<0.001]。相比之下，内脏肥胖和皮下肥胖与生存改善相关[内脏肥胖的HR为0.69（95%CI：0.57-0.82），<0.001；皮下肥胖的HR为0.78（95%CI：0.64-0.95），=0.015]，在较高脂肪水平下未观察到负面影响。这些变化与临终生存时间相关。
在晚期结直肠癌姑息化疗期间经常观察到身体成分异常和变化；肌少脂性肥胖很常见。全面的身体成分评估无需额外检测即可提供有价值的预后见解。
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