Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

Stéphanie M L M Looijaard, Carel G M Meskers, Monique S Slee-Valentijn, Donald E Bouman, A N Machteld Wymenga, Joost M Klaase, Andrea B Maier

Research output: Contribution to JournalArticleAcademicpeer-review


BACKGROUND: Current literature is inconsistent in the associations between computed tomography (CT)-based body composition measures and adverse outcomes in older patients with colorectal cancer (CRC). Moreover, the associations with consecutive treatment modalities have not been studied. This study compared the associations of CT-based body composition measures with surgery- and chemotherapy-related complications and survival in older patients with CRC.

MATERIALS AND METHODS: A retrospective single-center cohort study was conducted in patients with CRC aged ≥65 years who underwent elective surgery between 2010 and 2014. Gender-specific standardized scores of preoperative CT-based skeletal muscle (SM), muscle density, intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), subcutaneous adipose tissue, IMAT percentage, SM/VAT, and body mass index (BMI) were tested for their associations with severe postoperative complications, prolonged length of stay (LOS), readmission, and dose-limiting toxicity using logistic regression and 1-year and long-term survival (range 3.7-6.6 years) using Cox regression. Bonferroni correction was applied to account for multiple testing.

RESULTS: The study population consisted of 378 patients with CRC with a median age of 73.4 (interquartile range 69.5-78.4) years. Severe postoperative complications occurred in 13.0%, and 39.4% of patients died during follow-up. Dose-limiting toxicity occurred in 77.4% of patients receiving chemotherapy (n = 53). SM, muscle density, VAT, SM/VAT, and BMI were associated with surgery-related complications, and muscle density, IMAT, IMAT percentage, and SM/VAT were associated with long-term survival. After Bonferroni correction, no CT-based body composition measure was significantly associated with adverse outcomes. Higher BMI was associated with prolonged LOS.

CONCLUSION: The associations between CT-based body composition measures and adverse outcomes of consecutive treatment modalities in older patients with CRC were not consistent or statistically significant.

IMPLICATIONS FOR PRACTICE: Computed tomography (CT)-based body composition, including muscle mass, muscle density, and intermuscular, visceral, and subcutaneous adipose tissue, showed inconsistent and nonsignificant associations with surgery-related complications, dose-limiting toxicity, and overall survival in older adults with colorectal cancer. This study underscores the need to verify whether CT-based body composition measures are worth implementing in clinical practice.

Original languageEnglish
Pages (from-to)e492-e501
JournalThe Oncologist
Issue number3
Early online date20 Nov 2019
Publication statusPublished - Mar 2020

Bibliographical note

© 2019 The Authors. The Oncologist published by Wiley Periodicals, Inc. on behalf of AlphaMed Press.


We thank Willem G.P.M. Looijaard for being the second assessor in case of doubt about inclusion or multiplication of surface area in included CT scans. Moreover, we thank Anna F. Voskuilen (A.V.) for analyzing a selection of CT scans to determine the interobserver correlation coefficient. This work was supported by the European Union's Horizon 2020 research and innovation program under the Marie-Sklodowska-Curie grant agreement 675003 (PANINI program) and by an unrestricted grant of the University of Melbourne, Australia, received by Professor Andrea B. Maier. The funders had no role in the design and conduct of the study, data collection and analysis, interpretation of data, or preparation of the manuscript. This study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The study was approved by the Medical Ethics Committee of the Amsterdam University Medical Center, location VU Medical Center, Amsterdam, The Netherlands (number of approval 2015.166) with site-specific approval of Medical Spectrum Twente, Enschede, The Netherlands. Written informed consent was waived because of the retrospective design of the study.

FundersFunder number
Horizon 2020 Framework Programme
University of Melbourne
Horizon 2020675003


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