Scholarlink

Background <p>Colorectal cancer remains a leading cause of cancer-related morbidity and mortality with stage III disease carrying a substantial risk of recurrence despite curative resection. Accurate risk stratification is essential to optimize surveillance and guide adjuvant therapy. Traditional risk models rely heavily on pathologic features, but recent studies suggest that body composition metrics, particularly imaging-based assessments of skeletal muscle mass, may offer additional prognostic value. The skeletal muscle index (SMI), derived from routine CT imaging, has emerged as a promising surrogate marker of frailty. However, the relationship between temporal changes in SMI and cancer recurrence remains poorly understood.</p> Methods <p>A retrospective cohort study was performed using single-institution data from over 500 patients who underwent resection for stage III colorectal malignancy. SMI at diagnosis (SMI<sub>dx</sub>) was measured using staging CT imaging and follow-up measurements (SMI<sub>fu</sub>) were obtained at the most recent scan prior to recurrence to capture changes preceding radiologic evidence of disease. Patients were paired using propensity score matching and temporal changes in SMI were evaluated using conditional logistic regressions. Receiver operating characteristics and decision curve analysis were performed to determine whether change in SMI can stratify patients into meaningful risk groups to guide surveillance.</p> Results <p>A decrease in SMI was independently associated with increased risk of disease recurrence with an odds ratio of 2.23 per 10% decline <i>(95% CI: 1.15–4.35, p = 0.018)</i>. Baseline muscle status was not associated with recurrence <i>(OR 1.01 per cm</i><sup><i>2</i></sup><i>/m</i><sup><i>2</i></sup><i>, 95% CI: 0.97–1.05, p = 0.585)</i>. The optimal risk stratification threshold was θ = 2.11%, (θ = SMI<sub>fu</sub> / SMI<sub>dx</sub> − 1) with a sensitivity of 90% and specificity of 60%. Decision curve analysis showed net clinical benefit over a wide range of thresholds, θ = ±11%. These results were reproduced in an internally validated cohort.</p> Conclusions <p>Postoperative decline in skeletal muscle index is a significant, independent predictor of colorectal cancer recurrence. Clinically relevant risk stratification thresholds have been proposed and support the conclusion that longitudinal monitoring of SMI may have value to escalate surveillance intensity rather than being a passive prognostic marker. Future studies should focus on validating these thresholds in large, multi-center cohorts.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Temporal change in skeletal muscle index as a predictor of recurrence for patients with locally advanced colorectal malignancy: a retrospective cohort study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年4月7日

查看全文
  • Noah B. Manz,
  • Jordan Reed,
  • Christopher D. Kanner,
  • Jeremy A. Dressler

摘要

Background

Colorectal cancer remains a leading cause of cancer-related morbidity and mortality with stage III disease carrying a substantial risk of recurrence despite curative resection. Accurate risk stratification is essential to optimize surveillance and guide adjuvant therapy. Traditional risk models rely heavily on pathologic features, but recent studies suggest that body composition metrics, particularly imaging-based assessments of skeletal muscle mass, may offer additional prognostic value. The skeletal muscle index (SMI), derived from routine CT imaging, has emerged as a promising surrogate marker of frailty. However, the relationship between temporal changes in SMI and cancer recurrence remains poorly understood.

Methods

A retrospective cohort study was performed using single-institution data from over 500 patients who underwent resection for stage III colorectal malignancy. SMI at diagnosis (SMIdx) was measured using staging CT imaging and follow-up measurements (SMIfu) were obtained at the most recent scan prior to recurrence to capture changes preceding radiologic evidence of disease. Patients were paired using propensity score matching and temporal changes in SMI were evaluated using conditional logistic regressions. Receiver operating characteristics and decision curve analysis were performed to determine whether change in SMI can stratify patients into meaningful risk groups to guide surveillance.

Results

A decrease in SMI was independently associated with increased risk of disease recurrence with an odds ratio of 2.23 per 10% decline (95% CI: 1.15–4.35, p = 0.018). Baseline muscle status was not associated with recurrence (OR 1.01 per cm2/m2, 95% CI: 0.97–1.05, p = 0.585). The optimal risk stratification threshold was θ = 2.11%, (θ = SMIfu / SMIdx − 1) with a sensitivity of 90% and specificity of 60%. Decision curve analysis showed net clinical benefit over a wide range of thresholds, θ = ±11%. These results were reproduced in an internally validated cohort.

Conclusions

Postoperative decline in skeletal muscle index is a significant, independent predictor of colorectal cancer recurrence. Clinically relevant risk stratification thresholds have been proposed and support the conclusion that longitudinal monitoring of SMI may have value to escalate surveillance intensity rather than being a passive prognostic marker. Future studies should focus on validating these thresholds in large, multi-center cohorts.