Related Experiment Video
Updated: Sep 10, 2025
Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
Preoperative myosteatosis and intermuscular adiposity as CT-Derived nutritional prognostic markers in colorectal
Yinghao Cao1, Yixin Heng2, Mingming Song3
1Department 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.
Background:
Body composition alterations quantified by routine preoperative imaging may refine risk stratification and guide nutritional interventions in colorectal cancer (CRC). We aimed to establish the prognostic value of CT-assessed muscle quality and ectopic fat deposition for long-term survival.
Methods:
This dual-center retrospective study analyzed 850 patients from Wuhan Union Hospital (original cohort) and 647 from Shihezi University Hospital (validation cohort) undergoing curative CRC resection. Using pretreatment abdominal CT at L3, we quantified: Adipose metrics: Visceral fat area (VFA), subcutaneous fat area (SFA), and intermuscular fat area (IMFA). Muscle metrics: Skeletal muscle index (SMI) and radiodensity (SMD) Sex-specific thresholds determined by X-tile categorized patients into high/low groups. Primary endpoints were overall survival (OS) and disease-free survival (DFS).
Results:
The mortality rates of the original cohort and the validation cohort were 25.65 % (218/850) and 26.28 % (170/647), respectively. Multivariable Cox regression analysis revealed that Myosteatosis (low SMD: HR 0.58, 95%CI 0.41-0.83), elevated IMFI (HR 1.61, 1.09-2.39), low SFA (HR 0.66, 0.44-0.98), and IMFA/VFA ratio (HR 1.52, 1.06-2.18) were independent prognostic factors for OS (all P < 0.050). High IMFA (HR 1.46, 1.02-2.08) and IMFA/SFA ratio (HR 1.57, 1.06-2.38) were also significantly associated with DFS (all P < 0.050). The model combining clinico-radiological (CRAD) factors demonstrated better predictive ability compared to the model based on Tumor Node Metastasis staging alone or in combination with body composition (AUC: Original cohort: 0.815 vs. 0.701/0.772 for OS, 0.794 vs. 0.720/0.755 for DFS; Validation cohort: 0.841 vs. 0.707/0.750 for OS and 0.736 vs. 0.662/0.676 for DFS). Decision curve analysis confirmed superior net benefit of CRAD model across risk thresholds.
Conclusions:
Low SMD and high IMFA independently predict adverse CRC outcomes. The CRAD model synergizing CT-derived body composition with clinical parameters enables personalized prognostic stratification, supporting targeted nutritional strategies to mitigate muscle quality deterioration and ectopic fat accumulation.
