Importance of Sex and the Distinction Between Colon and Rectal Cancer in the Association of Body Composition with Postoperative Mortality
Main Article Content
Abstract
Background: Muscle and fat influence outcome after colorectal cancer surgery. Little data exist on mortality. Muscle mass (MM) relating to lower mortality is mostly studied in dichotomous approaches as sarcopenia or skeletal muscle index (SMI) but rarely as a continuous variable. For fat, compartments as visceral, subcutaneous, or intramuscular have different metabolic impact but on mortality little is known. Sex dictates muscle and fat mass that also may differ between colon and rectal cancer patients.
Objective: To study associations of muscle and fat parameters as continuous variables with mortality in men and women after colon or rectal cancer resection.
Design: Retrospective multicenter cohort study
Setting: This study used data of the Dutch Surgical Colorectal Audit from 2011 through 2014 from 8 Dutch teaching hospitals. Body composition was assessed on pre-operative CT scans.
Patients: 2597 colon and 931 rectal cancer patients
Main outcome measures: Associations of muscle and fat measures with 5- year MR in male and female colon and rectal cancer patients.
Results: Negative associations of MM and SMI and positive associations of muscle fat (MF) and sarcopenia with mortality were found only in male patients. The effect of MM and sarcopenia was found in both colon and rectal patients whereas SMI had no effect in rectal patients. Muscle fat associated with higher mortality only in male colon patients. The only effect of visceral fat was seen in male rectal cancer patients associating with lower mortality.
Limitations: The retrospective nature of the study
Conclusion: The male predominance and differences between colon and rectal cancer patients for associations of muscle and fat parameters with colorectal cancer mortality stress the importance of separating males from females and colon from rectal cancer patients in the analysis of body composition effects on mortality.
Article Details
How to Cite
VERDUIN, Wouter M. et al.
Importance of Sex and the Distinction Between Colon and Rectal Cancer in the Association of Body Composition with Postoperative Mortality.
Medical Research Archives, [S.l.], v. 11, n. 6, june 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3917>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v11i6.3917.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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11. Harman-Boehm I, Blüher M, Redel H, et al. Macrophage infiltration into omental versus subcutaneous fat across different populations: Effect of regional adiposity and the comorbidities of obesity. Journal of Clinical Endocrinology and Metabolism. 2007;92(6):2240-2247. doi:10.1210/jc.2006-1811
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14. Kelley DE, Goodpaster B, Wing RR, Simoneau JA. Skeletal muscle fatty acid metabolism in association with insulin resistance, obesity, and weight loss. Am J Physiol Endocrinol Metab. 1999;277(6 40-6). doi:10.1152/ajpendo.1999.277.6.e1130
15. Wolfe RR. The underappreciated role of muscle in health and disease. 2006;84:475-482. https://academic.oup.com/ajcn/article/84/3/475/4648841
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20. Weijs PJM, Looijaard WGPM, Dekker IM, et al. Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients. Crit Care. 2014;18(1):1-7. doi:10.1186/cc13189
21. Ales K, St D, Charlson ME, Pompei P, Ales KL, Mackenzie CR. A New Method of Classifying Prognostic Comorbidity In Longitudinal Studies: Development and Validations. J Chronic Dis. 1987;40(5):373-383.
22. van Vugt JLA, Coebergh van den Braak RRJ, Lalmahomed ZS, et al. Impact of low skeletal muscle mass and density on short and long-term outcome after resection of stage I-III colorectal cancer. European Journal of Surgical Oncology. 2018;44(9):1354-1360. doi:10.1016/j.ejso.2018.05.029
23. Hopkins JJ, Reif RL, Bigam DL, Baracos VE, Eurich DT, Sawyer MB. The impact of muscle and adipose tissue on long-term survival in patients with stage I to III colorectal cancer. Dis Colon Rectum. 2019;62(5):549-560. doi:10.1097/DCR.0000000000001352
24. Ojima Y, Harano M, Sumitani D, Okajima M. Impact of Preoperative Skeletal Muscle Mass and Quality on the Survival of Elderly Patients After Curative Resection of Colorectal Cancer. J Anus Rectum Colon. 2019;3(4):143-151. doi:10.23922/jarc.2018-034
25. Haizlip KM, Harrison BC, Leinwand LA. Sex-based differences in skeletal muscle kinetics and fiber-type composition. Physiology. 2015;30(1):30-39. doi:10.1152/physiol.00024.2014
26. Glenmark B, Nilsson M, Gao H, Gustafsson JÅ, Dahlman-Wright K, Westerblad H. Difference in skeletal muscle function in males vs. females: Role of estrogen receptor-β. Am J Physiol Endocrinol Metab. 2004;287(6 50-6):1125-1131. doi:10.1152/ajpendo.00098.2004
27. Zhang X, Xie X, Dou Q, et al. Association of sarcopenic obesity with the risk of all-cause mortality among adults over a broad range of different settings: A updated meta-analysis. BMC Geriatr. 2019;19(1). doi:10.1186/s12877-019-1195-y
28. Beliaeff S, Bouchard DR, Hautier C, Brochu M, Dionne IJ. Association between muscle mass and isometric muscle strength in well-functioning older men and women. J Aging Phys Act. 2008;16(4):484-493. doi:10.1123/japa.16.4.484
29. Newman AB, Kupelian V, Visser M, et al. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. Journals of Gerontology - Series A Biological Sciences and Medical Sciences. 2006;61(1):72-77. doi:10.1093/gerona/61.1.72
30. Chait A, den Hartigh LJ. Adipose Tissue Distribution, Inflammation and Its Metabolic Consequences, Including Diabetes and Cardiovascular Disease. Front Cardiovasc Med. 2020;7(February):1-41. doi:10.3389/fcvm.2020.00022
31. Malietzis G, Johns N, Al-Hassi HO, et al. Low muscularity and myosteatosis is related to the host systemic inflammator y response in patients undergoing surger y for colorectal cancer. Ann Surg. 2016;263(2):320-325. doi:10.1097/SLA.0000000000001113
32. Lara-Castro C, Garvey WT. Intracellular Lipid Accumulation in Liver and Muscle and the Insulin Resistance Syndrome. Endocrinol Metab Clin North Am. 2008;37(4):841-856. doi:10.1016/j.ecl.2008.09.002
33. Okugawa Y, Toiyama Y, Yamamoto A, et al. Clinical Impact of Muscle Quantity and Quality in Colorectal Cancer Patients: A Propensity Score Matching Analysis. Journal of Parenteral and Enteral Nutrition. 2018;42(8):1322-1333. doi:10.1002/jpen.1171
34. Rickles AS, Iannuzzi JC, Mironov O, et al. Visceral Obesity and Colorectal Cancer: Are We Missing the Boat with BMI? Journal of Gastrointestinal Surgery. 2013;17(1):133-143. doi:10.1007/s11605-012-2045-9
35. Tamas K, Walenkamp AME, de Vries EGE, et al. Rectal and colon cancer: Not just a different anatomic site. Cancer Treat Rev. 2015;41(8):671-679. doi:10.1016/J.CTRV.2015.06.007
36. Clark W, Siegel EM, Chen YA, et al. Quantitative measures of visceral adiposity and body mass index in predicting rectal cancer outcomes after neoadjuvant chemoradiation. J Am Coll Surg. 2013;216(6):1070-1081. doi:10.1016/j.jamcollsurg.2013.01.007
37. Lee KH, Kang B kyeong, Ahn BK. Higher visceral fat area/subcutaneous fat area ratio measured by computed tomography is associated with recurrence and poor survival in patients with mid and low rectal cancers. Int J Colorectal Dis. 2018;33(9):1303-1307. doi:10.1007/s00384-018-3065-z
38. van Vledder MG, Levolger S, Ayez N, Verhoef C, Tran TCK, Ijzermans JNM. Body composition and outcome in patients undergoing resection of colorectal liver metastases. British Journal of Surgery. 2012;99(4):550-557. doi:10.1002/bjs.7823
2. Gendall KA, Raniga S, Kennedy R, Frizelle FA. The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum. 2007;50(12):2223-2237. doi:10.1007/s10350-007-9051-0
3. Heus C, Cakir H, Lak A, Houdijk APJ. Visceral obesity , muscle mass and outcome in rectal cancer surgery after neo-adjuvant chemo-radiation. 2016;29:159-164. doi:10.1016/j.ijsu.2016.03.066
4. Goodpaster BH, Krishnaswami S, Resnick H, et al. Association Between Regional Adipose Tissue Distribution and Both Type 2 Diabetes and Impaired Glucose Tolerance in Elderly Men and Women. Vol 26.; 2003.
5. Fox CS, Massaro JM, Hoffmann U, et al. Abdominal visceral and subcutaneous adipose tissue compartments: Association with metabolic risk factors in the framingham heart study. Circulation. 2007;116(1):39-48. doi:10.1161/CIRCULATIONAHA.106.675355
6. Tchernof A, Després JP. Pathophysiology of human visceral obesity: An update. Physiol Rev. 2013;93(1):359-404. doi:10.1152/physrev.00033.2011
7. Mathieu P, Poirier P, Pibarot P, Lemieux I, Després JP. Visceral obesity the link among inflammation, hypertension, and cardiovascular disease. Hypertension. 2009;53(4):577-584. doi:10.1161/HYPERTENSIONAHA.108.110320
8. Hunter GR, Gower BA, Kane BL. Age Related Shift in Visceral Fat. Int J Body Compos Res. 2010;8(3):103-108. http://www.ncbi.nlm.nih.gov/pubmed/24834015%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4018766
9. Hiuge-Shimizu A, Kishida K, Funahashi T, et al. Absolute value of visceral fat area measured on computed tomography scans and obesity-related cardiovascular risk factors in large-scale Japanese general population (the VACATION-J study). Ann Med. 2012;44(1):82-92. doi:10.3109/07853890.2010.526138
10. Verduin WM, Warps A loes K, van den Helder R, Doodeman HJ, Houdijk APJ. Visceral Fat and Anastomotic Leakage After Colon Cancer Resection. Dis Colon Rectum. Published online 2021:163-170. doi:10.1097/dcr.0000000000001779
11. Harman-Boehm I, Blüher M, Redel H, et al. Macrophage infiltration into omental versus subcutaneous fat across different populations: Effect of regional adiposity and the comorbidities of obesity. Journal of Clinical Endocrinology and Metabolism. 2007;92(6):2240-2247. doi:10.1210/jc.2006-1811
12. Goulart A, Malheiro N, Rios H, Sousa N, Leão P. Influence of visceral fat in the outcomes of colorectal cancer. Dig Surg. 2018;36(1):33-40. doi:10.1159/000486143
13. Alvehus M, Burén J, Sjöström M, Goedecke J, Olsson T. The human visceral fat depot has a unique inflammatory profile. Obesity. 2010;18(5):879-883. doi:10.1038/oby.2010.22
14. Kelley DE, Goodpaster B, Wing RR, Simoneau JA. Skeletal muscle fatty acid metabolism in association with insulin resistance, obesity, and weight loss. Am J Physiol Endocrinol Metab. 1999;277(6 40-6). doi:10.1152/ajpendo.1999.277.6.e1130
15. Wolfe RR. The underappreciated role of muscle in health and disease. 2006;84:475-482. https://academic.oup.com/ajcn/article/84/3/475/4648841
16. Caan BJ, Meyerhardt JA, Kroenke CH, et al. Explaining the Obesity Paradox : The Association between Body Composition and Colorectal Cancer Survival ( C-SCANS Study ). Published online 2017:1-9. doi:10.1158/1055-9965.EPI-17-0200
17. van Baar H, Winkels RM, Brouwer JGM, et al. Associations of Abdominal Skeletal Muscle Mass, Fat Mass, and Mortality among Men and Women with Stage I-III Colorectal Cancer. Cancer Epidemiol Biomarkers Prev. 2020;29(5):956-965. doi:10.1158/1055-9965.EPI-19-1134
18. van der Sanden G, Coebergh J ww, Schouten LJ, van Leeuwen F. The Netherlands in 1989 and 1990: First Results of the Nationwide Netherlands Cancer EurJ Cancer. Vol 31.; 1995.
19. Rössner S, Bo WJ, Hiltbrandt E, Hinson W, Karstaedt N, Santago P. Adipose tissue determinations in cadavers--a comparison between cross-sectional planimetry and computed tomography. Int J Obes. 1990;14(10):893-902.
20. Weijs PJM, Looijaard WGPM, Dekker IM, et al. Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients. Crit Care. 2014;18(1):1-7. doi:10.1186/cc13189
21. Ales K, St D, Charlson ME, Pompei P, Ales KL, Mackenzie CR. A New Method of Classifying Prognostic Comorbidity In Longitudinal Studies: Development and Validations. J Chronic Dis. 1987;40(5):373-383.
22. van Vugt JLA, Coebergh van den Braak RRJ, Lalmahomed ZS, et al. Impact of low skeletal muscle mass and density on short and long-term outcome after resection of stage I-III colorectal cancer. European Journal of Surgical Oncology. 2018;44(9):1354-1360. doi:10.1016/j.ejso.2018.05.029
23. Hopkins JJ, Reif RL, Bigam DL, Baracos VE, Eurich DT, Sawyer MB. The impact of muscle and adipose tissue on long-term survival in patients with stage I to III colorectal cancer. Dis Colon Rectum. 2019;62(5):549-560. doi:10.1097/DCR.0000000000001352
24. Ojima Y, Harano M, Sumitani D, Okajima M. Impact of Preoperative Skeletal Muscle Mass and Quality on the Survival of Elderly Patients After Curative Resection of Colorectal Cancer. J Anus Rectum Colon. 2019;3(4):143-151. doi:10.23922/jarc.2018-034
25. Haizlip KM, Harrison BC, Leinwand LA. Sex-based differences in skeletal muscle kinetics and fiber-type composition. Physiology. 2015;30(1):30-39. doi:10.1152/physiol.00024.2014
26. Glenmark B, Nilsson M, Gao H, Gustafsson JÅ, Dahlman-Wright K, Westerblad H. Difference in skeletal muscle function in males vs. females: Role of estrogen receptor-β. Am J Physiol Endocrinol Metab. 2004;287(6 50-6):1125-1131. doi:10.1152/ajpendo.00098.2004
27. Zhang X, Xie X, Dou Q, et al. Association of sarcopenic obesity with the risk of all-cause mortality among adults over a broad range of different settings: A updated meta-analysis. BMC Geriatr. 2019;19(1). doi:10.1186/s12877-019-1195-y
28. Beliaeff S, Bouchard DR, Hautier C, Brochu M, Dionne IJ. Association between muscle mass and isometric muscle strength in well-functioning older men and women. J Aging Phys Act. 2008;16(4):484-493. doi:10.1123/japa.16.4.484
29. Newman AB, Kupelian V, Visser M, et al. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. Journals of Gerontology - Series A Biological Sciences and Medical Sciences. 2006;61(1):72-77. doi:10.1093/gerona/61.1.72
30. Chait A, den Hartigh LJ. Adipose Tissue Distribution, Inflammation and Its Metabolic Consequences, Including Diabetes and Cardiovascular Disease. Front Cardiovasc Med. 2020;7(February):1-41. doi:10.3389/fcvm.2020.00022
31. Malietzis G, Johns N, Al-Hassi HO, et al. Low muscularity and myosteatosis is related to the host systemic inflammator y response in patients undergoing surger y for colorectal cancer. Ann Surg. 2016;263(2):320-325. doi:10.1097/SLA.0000000000001113
32. Lara-Castro C, Garvey WT. Intracellular Lipid Accumulation in Liver and Muscle and the Insulin Resistance Syndrome. Endocrinol Metab Clin North Am. 2008;37(4):841-856. doi:10.1016/j.ecl.2008.09.002
33. Okugawa Y, Toiyama Y, Yamamoto A, et al. Clinical Impact of Muscle Quantity and Quality in Colorectal Cancer Patients: A Propensity Score Matching Analysis. Journal of Parenteral and Enteral Nutrition. 2018;42(8):1322-1333. doi:10.1002/jpen.1171
34. Rickles AS, Iannuzzi JC, Mironov O, et al. Visceral Obesity and Colorectal Cancer: Are We Missing the Boat with BMI? Journal of Gastrointestinal Surgery. 2013;17(1):133-143. doi:10.1007/s11605-012-2045-9
35. Tamas K, Walenkamp AME, de Vries EGE, et al. Rectal and colon cancer: Not just a different anatomic site. Cancer Treat Rev. 2015;41(8):671-679. doi:10.1016/J.CTRV.2015.06.007
36. Clark W, Siegel EM, Chen YA, et al. Quantitative measures of visceral adiposity and body mass index in predicting rectal cancer outcomes after neoadjuvant chemoradiation. J Am Coll Surg. 2013;216(6):1070-1081. doi:10.1016/j.jamcollsurg.2013.01.007
37. Lee KH, Kang B kyeong, Ahn BK. Higher visceral fat area/subcutaneous fat area ratio measured by computed tomography is associated with recurrence and poor survival in patients with mid and low rectal cancers. Int J Colorectal Dis. 2018;33(9):1303-1307. doi:10.1007/s00384-018-3065-z
38. van Vledder MG, Levolger S, Ayez N, Verhoef C, Tran TCK, Ijzermans JNM. Body composition and outcome in patients undergoing resection of colorectal liver metastases. British Journal of Surgery. 2012;99(4):550-557. doi:10.1002/bjs.7823