The impact of sarcopenia on pathologic complete response following neoadjuvant chemoradiation in rectal cancer
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ORIGINAL ARTICLE
The impact of sarcopenia on pathologic complete response following neoadjuvant chemoradiation in rectal cancer Tolga Olmez 1 & Cem Batuhan Ofluoglu 1 & Ozlem Zeliha Sert 2 & Sevinc Hallac Keser 3 & Selcuk Gulmez 1 & Aziz Serkan Senger 1 & Orhan Uzun 1 & Mustafa Duman 1 & Erdal Polat 1 Received: 3 July 2020 / Accepted: 1 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The role of sarcopenia in pathologic complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT) in non-metastatic locally advanced rectal cancer is currently unknown. The present study investigates the association between sarcopenia and post-nCRT pCR. Methods The data of patients operated on following nCRT between January 2013 and January 2020 were collected retrospectively. Sarcopenia was diagnosed based on the calculation of the skeletal muscle index (SMI) from computed tomography carried out at the time of the initial diagnosis. A statistical analysis was then conducted for predictors of pCR. Results The study included 61 patients with an average age of 57.3 years, 28 of whom formed the non-sarcopenic group (NSG) and 33 the sarcopenic group (SG). Of the patients, 32.7% were at clinical stage 2, and 67.3% were at clinical stage 3. Pathologic data following a mesorectal excision revealed a pCR rate of 21.4% in the NSG compared with 3% in the SG, which was a statistically significant difference (p = 0.025). The TNM downstaging rate was higher in the NSG than in the SG, although the difference was not statistically significant (50% vs. 33.3%, p = 0.28). A univariate analysis revealed the factors affecting pCR to be non-sarcopenia (p = 0.025), age < 61 years (p = 0.004), interval to surgery ≥ 8 weeks (p = 0.029), and serum CEA < 2.5 ng/ml (p = 0.035). Conclusion Sarcopenia was found to be a negative marker of pCR following nCRT in non-metastatic locally advanced rectal cancer. Keywords Sarcopenia . Rectal cancer . Pathologic complete response
Introduction Neoadjuvant chemoradiotherapy (nCRT) is a standard treatment for reducing the high risk of loco-regional recurrence following surgical procedures in patients with locally advanced rectal cancer [1–3]. nCRT also ensures downstaging in two-thirds and pathologic complete response (pCR) in onefifth of patients [4–6]. pCR, in turn, is associated with low local recurrence and prolonged disease-free survival [7–9].
* Tolga Olmez [email protected] 1
Department of Gastrointestinal Surgery, Kosuyolu Research and Education Hospital, University of Health Sciences, 34865 Istanbul, Turkey
2
Department of Surgery, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
3
Department of Pathology, Dr. Lutfi Kirdar Kartal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
In previous retrospective studies, such pCR-related factors as preoperative CRT, the tumor diameter, the level of carcinoembryonic antigen (CEA), and obesity have been reported [10, 11]. Total meso
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