Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2025; 17(5): 103479
Published online May 15, 2025. doi: 10.4251/wjgo.v17.i5.103479
Longitudinal changes in body composition during palliative systemic chemotherapy and survival outcomes in metastatic colorectal cancer
Hyehyun Jeong, Yousun Ko, Kyung Won Kim, Ji Sung Lee, Seyoung Seo, Sun Young Kim, Yong Sang Hong, Jeong Eun Kim, Tae Won Kim
Hyehyun Jeong, Seyoung Seo, Sun Young Kim, Yong Sang Hong, Jeong Eun Kim, Tae Won Kim, Department of Oncology, Asan Medical Center, Seoul 05505, South Korea
Yousun Ko, Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul 05505, South Korea
Kyung Won Kim, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Ji Sung Lee, Clinical Research Center, Asan Medical Center, Asan Medical Center, Seoul 05505, South Korea
Co-corresponding authors: Jeong Eun Kim and Tae Won Kim.
Author contributions: Jeong H performed formal analysis, conducted investigations, prepared the initial draft of the manuscript, and created visualizations for the study; Ko Y and Kim KW developed the software used in this study and analyzed imaging data; Lee JS performed formal analysis; Seo S, Kim SY, and Hong YS curated data; Kim SY, Kim JE and Kim TW obtained the funds for the research project; All authors reviewed and edited the manuscript. Kim JE and Kim TW proposed, conceptualized, and supervised the study, interpreted the data, and managed project administration.
Supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, by the Ministry of Health & Welfare, Republic of Korea, No. RS-2018-KH049509; and the 2022 Cancer Research Support Project from the Korea Foundation for Cancer Research, No. CB-2022-A-3.
Institutional review board statement: This study was approved by the institutional review board of Asan Medical Center and performed in accordance with the ethical standards of the institutional research committee and the Declaration of Helsinki (IRB No. 2021-0078).
Informed consent statement: The requirement for informed consent was waived by the IRB for this retrospective study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request at jeongeunkim@amc.seoul.kr.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jeong Eun Kim, MD, PhD, Department of Oncology, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. jeongeunkim@amc.seoul.kr
Received: November 21, 2024
Revised: February 22, 2025
Accepted: April 15, 2025
Published online: May 15, 2025
Processing time: 175 Days and 22.5 Hours
Abstract
BACKGROUND

In patients with metastatic colorectal cancer, chemotherapy may lead to changes in body composition, including skeletal muscle quantity and quality, and body fat area and distribution. Longitudinal follow-up data in a homogeneous population are required to understand these changes better.

AIM

To comprehensively evaluate changes in body composition and their prognostic value in patients with metastatic colorectal cancer undergoing palliative chemotherapy.

METHODS

This retrospective study included patients with recurrent or metastatic colorectal cancer who received palliative chemotherapy between 2008 and 2017. Computed tomography scans were analyzed at multiple time points (before each new chemotherapy regimen and after discontinuing all chemotherapy). Body composition was analyzed from each scan using artificial intelligence software (AID-UTM, iAID Inc.), and its association with survival was evaluated through time-dependent Cox regression to adjust for time-varying effects.

RESULTS

This analysis included 1805 patients, with a median age at diagnosis of 57 years, and 62% were male. At first-line chemotherapy initiation, 4.7%, 30.9%, 36.5%, and 37.1% of the patients had sarcopenia, myosteatosis, and visceral and subcutaneous obesity, respectively. During treatment, approximately 54.5% of the patients experienced significant changes in body composition, with 9.1% and 19.2% developing new sarcopenia and myosteatosis, respectively. Sarcopenia and myosteatosis were associated with poorer survival outcomes [hazard ratio (HR) for sarcopenia, 2.55 (95%CI: 2.06-3.16, P < 0.001; HR for myosteatosis, 2.37 (95%CI: 2.00-2.82), P < 0.001]. In contrast, visceral and subcutaneous obesity were associated with improved survival [HR for visceral obesity, 0.69 (95%CI: 0.57-0.82), P < 0.001; HR for subcutaneous obesity, 0.78 (95%CI: 0.64-0.95), P = 0.015], with no negative impacts observed at higher fat levels. These changes correlated with end-of-life survival time.

CONCLUSION

Abnormalities and body composition changes were frequently observed during palliative chemotherapy for advanced colorectal cancer; myosteatosis was common. Comprehensive body composition assessment offers valuable prognostic insights without requiring additional testing.

Keywords: Sarcopenia; Myosteatosis; Obesity; Body composition; Metastatic colorectal cancer; Palliative systemic treatment; Chemotherapy; Deep learning; Artificial intelligence

Core Tip: This retrospective study included a homogeneous group of patients with metastatic colorectal cancer undergoing palliative chemotherapy, monitoring body composition changes through serial computed tomography scans during treatment. The majority of patients experienced changes in body composition, with an increased prevalence of sarcopenia and myosteatosis, both linked to poor survival outcomes. In contrast, visceral and subcutaneous obesity were associated with improved survival. Furthermore, changes in body composition during systemic therapy correlated with end-of-life survival. These findings suggest the prognostic value of monitoring body composition through routine computed tomography scans during chemotherapy.