Dynamic postoperative trajectory of osteosarcopenia predicts the long-term outcomes in colorectal cancer

Osteosarcopenia (OSP) is a predictor of adverse outcomes after colorectal cancer (CRC) surgery. However, the prognostic impact of postoperative evolution remains unknown. This study evaluated the effect of dynamic changes in the OSP status between baseline and one year post-curative resection on the long-term prognosis.

This retrospective study analyzed 641 patients who were recurrence-free one year after post-resection. The OSP status was assessed using CT at baseline and one year postoperatively. A 1-year landmark analysis was performed to adjust for any immortal time bias. Patients were categorized according to their OSP trajectory as follows: Maintained non-OSP, Improved, Worsened, or Non-improved. The outcomes were analyzed using Kaplan-Meier curves and multivariate Cox regression models.

The prevalence at one year was 10%. Overall survival (OS) showed significant hierarchical disparities across the groups (P < 0.0001). The 5-year OS from the 1-year landmark was highest in the Improved group (96.7%) and lowest in the Non-improved group (43.3%). A multivariate analysis identified the postoperative OSP trajectory as the strongest independent risk factor for poor recurrence-free survival (HR 9.82; p < 0.0001) and a significant independent prognostic factor for overall survival (OS) (HR 3.39; p < 0.0001).

The postoperative OSP dynamics are significantly associated with the prognosis after CRC surgery and serve as useful prognostic indicators for cancer survivors.