Body composition as a predictor of cancer-related death in colon cancer: an AI-based volumetric analysis

To investigate body composition as a predictive biomarker of cancer-related death in patients with non-metastatic colon cancer (CRC).

Patients with CRC (stages II-III) treated with upfront surgery, with availability of baseline CT, clinico-histological and survival data were retrospectively enrolled. Patients with stage IV or CT unavailability were excluded. Body composition parameters derived from baseline abdominal CT using AI-based automatic segmentation software. Seventy-six parameters regarding adipose visceral fat(AVF), subcutaneous fat(SF), bone density, liver density, and fat-fraction were automatically extracted from both whole segmentation volume and multislices region. According to the CRC-related death (CRC-related death), the population was divided into Group 1 (CRC-related death) and Group 2 (non-CRC-related death). Body composition features were compared between two groups. Predictive model and survival analysis were performed with ROC curves, Cox regression, and Kaplan-Meier method. P < 0.05 was considered significant.

A total of 293 patients were included, 101/293(34.5%) with CRC-related deaths. MeanHU of AVF and SF resulted directly correlated with CRC-related death (P = 0.004 and HR = 1.03, P = 0.002 and HR = 1.04, respectively) for the multislice analysis. MeanHU of AVF resulted in direct correlation with CRC-related deaths, also for the volumetric analysis (P = 0.04 and HR = 1.02). In multivariable Cox regression analysis, MeanHU AVF was confirmed as an independent predictor of CRC-related death in both multislice and volumetric analyses. SF HU remained significant in multislice analysis. In Kaplan-Meier analysis, AVF and SF for the multislice analysis resulted statistically significant (P = 0.033 and < 0.001, Chi-square = 4.56 and 11.7, respectively).

In conclusion, our study demonstrated that body composition metrics of visceral and subcutaneous fat were significantly associated with cancer-related death in non-metastatic CRC patients.