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.