Preoperative myosteatosis and intermuscular adiposity as CT-Derived nutritional prognostic markers in colorectal cancer: A multicenter development-validation study

Yinghao Cao ¹, Yixin Heng ², Mingming Song ³

⁰Department of Digestive Surgical Oncology, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China; Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.

Nutrition +

|

August 22, 2025

View abstract on PubMed

Summary

Low skeletal muscle radiodensity (SMD) and high intermuscular fat area (IMFA) predict poor outcomes in colorectal cancer (CRC) patients. A combined clinico-radiological (CRAD) model using CT-assessed body composition improves prognostic accuracy.

Area Of Science

Oncology
Radiology
Body Composition Analysis

Background

Routine preoperative imaging in colorectal cancer (CRC) can assess body composition.
These assessments may enhance risk stratification and guide nutritional interventions.
The prognostic value of CT-assessed muscle quality and ectopic fat for survival needs establishment.

Purpose Of The Study

To determine the prognostic significance of CT-quantified muscle quality and ectopic fat deposition.
To evaluate the predictive capability of a combined clinico-radiological (CRAD) model for CRC survival.

Main Methods

Retrospective analysis of 850 (Wuhan Union Hospital) and 647 (Shihezi University Hospital) CRC patients.
Pretreatment abdominal CT at L3 quantified adipose metrics (VFA, SFA, IMFA) and muscle metrics (SMI, SMD).
Sex-specific thresholds categorized patients; primary endpoints were overall survival (OS) and disease-free survival (DFS).

Main Results

Low skeletal muscle radiodensity (SMD) and high intermuscular fat area (IMFA) were independent prognostic factors for OS.
Elevated IMFA and IMFA/VFA ratio were associated with poorer OS; high IMFA and IMFA/SFA ratio with DFS.
The CRAD model demonstrated superior predictive ability for OS and DFS compared to TNM staging alone or with body composition.

Conclusions

Low SMD and high IMFA independently predict adverse outcomes in CRC.
The CRAD model, integrating CT-derived body composition with clinical data, enables personalized prognostic stratification.
This approach supports targeted nutritional strategies to address muscle quality deterioration and ectopic fat accumulation.

Keywords:

Colorectal cancer Computed tomography Nutritional risk Prognostic mode Sarcopenia Sarcopenic obesity

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