Sarcopenia in patients with colorectal cancer: A comprehensive review

Table 1 Current studies of the effects of sarcopenia in patients with colorectal cancer

Ref.	Population (n)/ Age (yr)/Study type	CRC stage (%)/Surgery/ chemo (%)/radio (%)	Evaluation of sarcopenia/ Sarcopenia prevalence (%)	Morbidity/ Complications	DFS/RFS/CSS	OS/Mortality
Hopkins et al[56]	n = 968/mean 65.8 yr/RS	CC (60.6) RC (39.4)/ Stage I (10.3), II (38.6), III (51)/ Surgery	CT cross sectional muscle analysis, skeletal muscle area/27.5% prevalence		Sarcopenia worse RFS (HR: 1.32) and CSS (HR: 1.46)	Sarcopenia worse OS (HR: 1.45)
Dolan et al[60]	n = 163/median 70 yr/PS	CC (44.2), RC (55.8)/ Stage 0 (4.9), I (20.9), II (35), III (32.5), IV (6.7)/ Surgery	CT cross sectional TPA at L3 and PI/19.6% prevalence	Sarcopenia associated with 30-d mortality (P = 0.042)		Sarcopenia associated with 1-year mortality (P = 0.046)
Da Cunha et al[74]	n = 72/mean 59.4/RS	CC (58.3) RC (41.7)/all stage IV/ Surgery (29.2) Chemo (76.4)	CT cross sectional SMI at L3 (cutoffs SMI < 41 cm2/m2 women, < 43 cm2/m2 men)/ 44.4% prevalence		Sarcopenia reduced PFS (P < 0.001), HR: 1.78	Sarcopenic reduced OS (HR: 1.86, P = 0.043)
Jochum et al[52]	n = 47/mean 59.3 yr/RS	All RC/ stage II (40), III (60)/Neo-A and surgery	CT Cross sectional skeletal muscle mass index at L3, SMI/ 51.1% prevalence	Sarcopenia associated with blood transfusion (P = 0.001). Higher postoperative complications in sarcopenic (OR= 3.81)
Herrod et al[62]	n = 169/mean 72 yr/RS	CRC/stage not reported/all had CRC resection	CT Cross sectional mean psoas density at L3/30% prevalence	Sarcopenia associated with: High grade complications (OR: 6.33, P = 0.007), increased anastomotic risk (OR: 14.37, P = 0.026)		Sarcopenia not associated with 1-year mortality (OR: 2.08, P = 0.23)
Vashi et al[47]	n = 112/median 53.3 yr/RS	CC (75.9), RC (24.1)/ Stage I (1.8), II (6.3), III (33), IV (58.9)/ A-Chemo.	CT cross-sectional PM area at L3. Skeletal muscle index cm2/m2 (< 38.5 women and < 52.4 men)/ 41.1% prevalence			Median survival in sarcopenia 17.8 vs 38.6 mo in non-sarcopenia (P = 0.001). Less survival in stage IV + sarcopenia (mortality HR: 4.0, P = 0.001)
Park et al[58]	n = 65/median 71 yr/RS	RC stage I (12.3), II (36.9), III (41.5)/ LAR (86.2), APR (13.8)/ Neo-A or A-Chemo	CT Cross sectional muscle mass (cm2) at L3, SMI or PI. (49 cm2/m2 men, 31 cm2/m2 women)/ 38.5% prevalence		5-year DFS: Lower in sarcopenic (37.4% vs 81.6%, HR: 3.52, P = 0.001)	5-year OS: Lower in sarcopenia (38.0%vs 92.5%, P < 0.001). HR: 6.08; P = 0.001
Kroenke et al[48]	n = 3262/ >70 yr (n = 1083)/ RS	CRC/ stages I-III/ all surgery	CT cross sectional muscle area at L3. Skeletal muscle radio density and muscle mass			Low SMD had higher overall mortality (HR: 1.61). Patients with low SMD and sarcopenia: Highest mortality (HR: 2.02)
Nakanishi et al[51]	n = 494/mean 66.1 yr/RS	CC (58), RC (42)/stage I (22), II (25), III (36), IV (17)/A-Chemo	CT Cross sectional muscle mass (cm2) at L3, SMI. (52.4 cm2/m2 men, 38.5 cm2/m2 women)/60% prevalence	Sarcopenia associated with higher overall complications (OR: 1.82, P = 0.01), longer hospital stay (P = 0.02).	Worse RFS of sarcopenic patients, but not significant (P = 0.09)	Sarcopenia did not correlate with OS (P = 0.31)
Womer et al[45]	n = 180/mean 62.7 yr/RS	RC Stage I (8.4), II (25.7), III (39.7), IV (13.4)/LAR (73.9), APR (26.1)/ Neo-A (86.1%)	CT cross-sectional PM at L3. Total psoas area, total psoas volume	Major 90-d morbidity with smaller TPA (6.7 vs 10.5 cm2/m2, P = 0.04) and TPV (26.7 vs 42.2 cm2/m2, P = 0.04)
Choi et al[59]	n = 188/mean 61.3/RS	All RC/stage II (18.1), III (81.9)/ Neo-A and surgery	CT Cross sectional skeletal muscle mass index at L3, SMI (52.4 cm2/m2 men, 38.5 cm2/m2 women)/ 39.4% prevalence		Sarcopenia did not shorten DFS (P = 0.900)	Sarcopenic had shorter OS (P = 0.004)
Miyamoto et al[50]	n = 220/mean 70 yr/RS	CC Stage I (35%), II (38), III (27)/ A-Chemo (25%)	CT Cross sectional muscle mass (cm2) at L3, with a three dimensional system. Normalized by height (m2)/25% prevalence		5-y RFS: 56 (sarcopenia) vs 79%, log-rank P = 0.006/ Shorter RFS HR: 2.1 (P = 0.010)	5-y OS: 68 (sarcopenia) vs 85%, log-rank P = 0.015/ Shorter OS HR 2.2 (P = 0.019)
Reisinger et al[61]	n = 310/ > 70 yr (51.3%)/PS	CC (66.1), RC (33.9)/ Stage I (5.5), II (70.6), III (20), IV (3.9)/ surgery	CT cross-sectional muscle area surface at L3, muscle index (52.4 cm2/m2 men, 38.5 cm2/m2 women)/47.7% prevalence	30-d and in-hospital mortality: 8.8% sarcopenia vs 0.7% non-sarcopenia (OR: 15.5, P = 0.001) Sarcopenia was not predictive for anastomotic leaks or sepsis
Huang et al[14]	n = 142/mean 62.03 yr/PS	CC (54.2) RC (45.3)/ Stage I (26), II (44.4), III (29.6)/ Surgery, Neo-A	CT Cross sectional muscle index at L, handgrip strength, gait speed/ 11.9% prevalence	Patients with sarcopenia had a higher incidence of postoperative complications (OR: 4.524, P = 0.007) and higher infectious complications (OR: 3.2, P = 0.052)
Jung et al[46]	n = 229/ Median 61 yr/RS	All stage III CC/ Curative surgery/ A-Chemo (FOLFOX4)	CT Cross sectional PM at L4, psoas index (psoas area(cm2)/height (m2)/ 25.3% prevalence	Increase in grade 3-4 chemotherapy toxicities (OR: 1.67), grade 3-4 neutropenia (OR: 1.56)		HR for mortality: 1.85 (P = 0.022)
Van Vledder et al[12]	n = 196/median 64.5 yr/RS	CC (59.2), RC (40.8)/ all stage IV (liver)/ surgery for metastases	CT cross-sectional muscle areas at L3. (< 41.1 cm2/m2 women and < 43.75 men)/19.4% prevalence		Sarcopenia: Shorter median DFS (8.7 vs 15.1 mo; P = 0.002)	Sarcopenia: Worse median overall survival (23.8 vs 59.8 mo; P = 0.001)
Peng et al[16]	n = 259/ median 58 yr/RS	CC (74), RC (27)/all stage IV (liver)/surgery for metastases	CT Cross sectional muscle mass at L3. TPA at L3 (mm/m2)/ 16% prevalence	Sarcopenia associated with overall morbidity risk (OR: 2.2; P = 0.02).; Sarcopenia associated with major complications (OR: 3.33; P = 0.008) and Longer stays (> 2 d; P = 0.004)	5-year RFS: 23% in sarcopenia vs 27% in non-sarcopenia (P = 0.78)	Sarcopenia was not associated with long-term OS.

CRC: Colorectal cancer; DFS: Disease free survival; RFS: Recurrence free survival; CSS: Cancer Specific Survival; OS: Overall survival; RS: retrospective study; PS: Prospective study; CC: Colon Cancer; RC: Rectal Cancer; LAR: Low anterior resection; APR: Abdominoperineal resection; A-Chemo: Adjuvant Chemotherapy; Neo-A: Neoadjuvant therapy; CT: Computed tomography; PM: Psoas muscle; OR: Odds ratio; HR: Hazard ratio.