Low radiographic muscle density is associated with lower overall and disease-free survival in early-stage colorectal cancer patients

Harm van Baar*, S. Beijer, M. J. L. Bours, M. P. Weijenberg, M. van Zutphen, F. J. B. van Duijnhoven, G. D. Slooter, J. F. M. Pruijt, J. J. Dronkers, A. Haringhuizen, E. J. Spillenaar Bilgen, B. M. E. Hansson, J. H. W. de Wilt, E. Kampman, R. M. Winkels

*Corresponding author for this work

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BackgroundIn cancer patients with a poor prognosis, low skeletal muscle radiographic density is associated with higher mortality. Whether this association also holds for early-stage cancer is not very clear. We aimed to study the association between skeletal muscle density and overall mortality among early-stage (stage I-III) colorectal cancer (CRC) patients. Furthermore, we investigated the association between skeletal muscle density and both CRC-specific mortality and disease-free survival in a subset of the study population.MethodsSkeletal muscle density was assessed in 1681 early-stage CRC patients, diagnosed between 2006 and 2015, using pre-operative computed tomography images. Adjusted Cox proportional hazard models were used to evaluate the association between muscle density and overall mortality, CRC-specific mortality and disease-free survival.ResultsThe median follow-up time was 48 months (range 0-119months). Low muscle density was detected in 39% of CRC patients. Low muscle density was significantly associated with higher mortality (low vs. normal: adjusted HR 1.91, 95% CI 1.53-2.38). After stratification for comorbidities, the association was highest in patients with 2 comorbidities (HR 2.11, 95% CI 1.55-2.87). Furthermore, low skeletal muscle density was significantly associated with poorer disease-free survival (HR 1.68, 95% CI 1.14-2.47), but not with CRC-specific mortality (HR 1.68, 95% CI 0.89-3.17) in a subset of the study population.ConclusionIn early-stage CRC patients, low muscle density was significantly associated with higher overall mortality, and worse disease-free survival.

Original languageEnglish
Pages (from-to)2139-2147
Number of pages9
JournalJournal of Cancer Research and Clinical Oncology
Issue number11
Publication statusPublished - Nov 2018


  • Colorectal cancer
  • Skeletal muscle density
  • Mortality
  • Survival

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