Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Original Article

Volume 9, Number 10, October 2017, pages 844-859

Validation of Skeletal Muscle Volume as a Nutritional Assessment in Patients With Gastric or Colorectal Cancer Before Radical Surgery

Figures

Figure 1.
Figure 1. Flow diagram according to selection and exclusion criteria.
Figure 2.
Figure 2. The differences in cumulative overall survival rates after surgery, according to the SMI classification. The SMI group with lower values (SMI values < 6.25 kg/m2 and < 5.17 kg/m2 in male and female patients, respectively) had significantly shorter survival rates than the SMI group with higher values (P = 0.019). SMI: smooth muscle index.
Figure 3.
Figure 3. The differences in cumulative survival rates after surgery from cancer-related deaths, according to the SMI classification. Patients with lower values of SMI had significantly shorter survivals than those with higher values of SMI (P = 0.013). SMI: smooth muscle index.

Tables

Table 1. Characteristics
 
n = 121
Data were expressed as n (%) or mean ± SD.
Age (years)70.3 ± 9.4
Sex
  Male (n, %)81 (66.9)
Stage (n = 118)
  Stage I-II74 (61.2)
  Stage III44 (36.4)
Disease
  Colorectal cancer82 (67.8)
  Stomach cancer39 (32.2)
Charlson comorbidity index (points)
  278 (64.5)
  331 (25.6)
  410 (8.3)
  52 (1.7)
CEA (ng/mL) (n = 117)21.7 ± 3.8
CA19-9 (U/mL) (n = 113)42.4 ± 161.8
CRP (mg/dL) (n = 104)0.7 ± 1.5
Albumin (g/dL) (n = 105)3.6 ± 0.6
Hemoglobin (g/dL) (n =107)12.0 ± 2.6
HbA1c (%) (n = 92)6.1 ± 0.9
PNI (points) (n = 100)45.0 ± 7.0
BMI (kg/m2)
  Male21.7 ± 3.8
  Female21.0 ± 3.5
SMI (kg/m2)
  Male6.8 ± 1.1
  Female5.5 ± 0.8
VFA (cm2)
  Male (n = 77)108.2 ± 62.9
  Female (n = 39)115.2 ± 77.9
Body fat (%)
  Male22.3 ± 7.2
  Female30.4 ± 9.0

 

Table 2. Univariate and Multivariate Hazard Ratio and 95% CI for Association of Postoperative Survival
 
Survive (n = 100)Death (n = 21)Univariate HR (95% CI)P-valueMultivariate HR (95% CI)P-value
PNI: prognostic nutritional index; CEA: carcinoembryonic antigen; CA19-9: carbohydrate antigen 19-9; CRP: C-reactive protein; VFA: visceral fat area; BMI: body mass index; SMI: skeletal muscle mass index. Multivariate model included age, CEA, albumin and SMI.
Age (years)
  < 7570811
  ≥ 7530134.03 (1.66 - 9.76)0.0022.44 (0.87 - 6.86)0.090
Sex
  Female3281
  Male68130.70 (0.29 - 1.68)0.420
Stage
  Stage I-II6681
  Stage III32122.45 (1.00 - 5.99)0.050
Failure: 3
Disease
  Colorectal cancer68141
  Stomach cancer3271.13 (0.45 - 2.80)0.796
Charlson comorbidity index (points)
  ≤ 291181
  > 3931.70 (0.50 - 5.79)0.394
Histological type
  Undifferentiated831
  Differentiated92180.52 (0.15 - 1.76)0.291
CEA (ng/mL)
  < 66291
  ≥ 635112.84 (1.17 - 6.93)0.0222.08 (0.74 - 5.88)0.168
Failure: 4
CA19-9 (U/mL)
  < 3781171
  ≥ 371231.16 (0.34 - 3.95)0.817
Failure: 8
CRP (mg/dL)
  < 0.24271
  ≥ 0.245101.20 (0.45 - 3.19)0.712
Failure: 17
Albumin (g/dL)
  ≥ 3.561811
  < 3.526102.94 (1.16 - 7.45)0.0231.56 (0.55 - 4.45)0.404
Failure: 16
Hemoglobin (g/dL)
  ≥ male 11; female 1067101
  < male 11; female 102283.41 (1.33 - 8.75)0.011
Failure: 14
HbA1c (%)
  < 6.561131
  ≥ 6.51530.69 (0.20 - 2.44)0.566
Failure: 29
PNI (points)
  ≥ 4066141
  < 401731.22 (0.35 - 4.27)0.752
Failure: 21
BMI (kg/m2)
  18.5 - 24.967141
  < 18.51751.27 (0.46 - 3.56)0.646
  ≥ 251620.58 (0.13 - 2.56)0.474
P for trend 0.352
SMI (kg/m2)
  ≥ male 6.25; female 5.17801211
  < male 6.25; female 5.172092.70 (1.13 - 6.41)0.0252.48 (0.91 - 6.81)0.077
VFA (cm2)
  ≥ 100 cm24791
  < 100 cm248121.20 (0.51 - 2.85)0.680
Failure: 5
Body fat (%)
  ≥ male 30; female 421221
  < male 30; female 4288191.07 (0.25 - 4.60)0.931
Treatment technique
  Laparoscopic2111
  Laparotomy79202.49 (0.33 - 18.90)0.378
Chemotherapy
  Absence65121
  Prescription3591.29 (0.54 - 3.06)0.565

 

Table 3. Univariate and Multivariate Hazard Ratio and 95% CI for Association of Postoperative Survival (Cancer Death)
 
Survive (n = 100)Death (n = 18)Univariate HR (95% CI)P-valueMultivariate HR (95% CI)P-value
PNI: prognostic nutritional index; CEA: carcinoembryonic antigen; CA19-9: carbohydrate antigen 19-9; CRP: C-reactive protein; VFA: visceral fat area; BMI: body mass index; SMI: skeletal muscle mass index. Multivariate model included age, albumin and SMI.
Age (years)
  < 7570711
  ≥ 7530113.90 (1.51 - 10.09)0.0052.35 (0.84 - 6.59)0.104
Sex
  Female3261
  Male68120.83 (0.31 - 2.21)0.706
Stage
  Stage I-II6671
  Stage III32102.54 (0.96 - 6.67)0.059
Failure: 3
Disease
  Colorectal cancer68121
  Stomach cancer3261.13 (0.42 - 3.00)0.813
Charlson comorbidity index (points)
  ≤ 291151
  > 3931.98 (0.57 - 6.87)0.280
Histological type
  Undifferentiated831
  Differentiated92150.43 (0.13 - 1.50)0.187
CEA (ng/mL)
  < 66281
  ≥ 63592.62 (1.00 - 6.85)0.050
Failure: 4
CA19-9 (U/mL)
  < 3781141
  ≥ 371231.36 (0.39 - 4.73)0.631
Failure: 8
CRP (mg/dL)
  < 0.24271
  ≥ 0.24581.05 (0.38 - 2.91)0.922
Failure: 16
Albumin (g/dL)
  ≥ 3.561711
  < 3.52693.22 (1.20 - 8.67)0.0212.83 (1.03 - 7.75)0.043
Failure: 15
Hemoglobin (g/dL)
  ≥ male 11; female 1067101
  < male 11; female 102262.90 (1.04 - 8.09)0.043
Failure: 13
HbA1c (%)
  < 6.561111
  ≥ 6.51530.78 (0.22 - 2.81)0.707
Failure: 28
PNI (points)
  ≥ 4066121
  < 401731.47 (0.41 - 5.21)0.555
Failure: 20
BMI (kg/m2)
  18.5 - 24.967121
  < 18.51741.33 (0.43 - 4.13)0.622
  ≥ 251620.65 (0.15 - 2.91)0.575
P for trend 0.403
SMI (kg/m2)
  ≥ male 6.25; female 5.17801011
  < male 6.25; female 5.172083.07 (1.21 - 7.78)0.0183.34 (1.21 - 9.17)0.020
VFA (cm2)
  ≥ 100 cm24781
  < 100 cm248101.16 (0.46 - 2.95)0.752
Failure: 5
Body fat (%)
  ≥ male 30; female 421221
  < male 30; female 4288160.98 (0.22 - 4.24)0.973
Treatment technique
  Laparoscopic210
  Laparotomy7918
Chemotherapy
  Absence65101
  Prescription3581.40 (0.55 - 3.55)0.477

 

Table 4. Univariate and Multivariate OR and 95% CI for Association of Postoperative Recurrence
 
Absence (n = 86)Recurrence (n = 35)Univariate OR (95% CI)P-valueMultivariate OR (95% CI)†P-value
PNI: prognostic nutritional index; CEA: carcinoembryonic antigen; CA19-9: carbohydrate antigen 19-9; CRP: C-reactive protein; VFA: visceral fat area; BMI: body mass index; SMI: skeletal muscle mass index. †Model included age, sex, stage and chemotherapy.
Age (years)
  < 75582011
  ≥ 7528151.55 (0.69 - 3.48)0.2851.78 (0.70 - 4.53)0.225
Sex
  Female31911
  Male55261.63 (0.68 - 3.91)0.2762.19 (0.80 - 5.98)0.126
Stage
  Stage I-II591511
  Stage III24203.28 (1.44 - 7.45)0.0052.20 (0.86 - 5.66)0.100
Failure: 3
Disease
  Colorectal cancer58241
  Stomach cancer28110.95 (0.41 - 2.21)0.904
Charlson comorbidity index (points)
  ≤ 279301
  > 3751.88 (0.55 - 6.39)0.311
Histological type
  Undifferentiated831
  Differentiated78321.09 (0.27 - 4.39)0.899
CEA (ng/mL)
  < 653181
  ≥ 630161.57 (0.70 - 3.53)0.274
Failure: 4
CA19-9 (U/mL)
  < 3773251
  ≥ 37872.56 (0.84 - 7.77)0.098
Failure: 8
CRP (mg/dL)
  < 0.236131
  ≥ 0.238171.24 (0.53 - 2.91)0.623
Failure: 17
Albumin (g/dL)
  ≥ 3.550191
  < 3.524121.32 (0.55 - 3.15)0.537
Failure: 16
Hemoglobin (g/dL)
  ≥ male 11; female 1053241
  < male 11; female 102460.55 (0.20 - 1.53)0.252
Failure: 14
HbA1c (%)
  < 6.554201
  ≥ 6.51261.35 (0.45 - 4.08)0.595
Failure: 29
PNI (points)
  ≥ 4055251
  < 401550.73 (0.24 - 2.24)0.586
Failure: 21
BMI (kg/m2)
  18.5 - 24.956251
  < 18.51750.66 (0.22 - 1.99)0.459
  ≥ 251350.86 (0.28 - 2.68)0.797
P for trend 0.686
SMI (kg/m2)
  ≥ male 6.25; female 5.1765271
  < male 6.25; female 5.172180.92 (0.36 - 2.32)0.855
VFA (cm2)
  ≥ 100 cm238181
  < 100 cm244160.77 (0.35 - 1.71)0.518
Failure: 5
Body fat (%)
  ≥ male 30; female 421131
  < male 30; female 4275321.56 (0.41 - 5.98)0.514
Treatment technique
  Laparoscopic1931
  Laparotomy67323.03 (0.83 - 10.97)0.092
Chemotherapy
  Absence641311
  Prescription22224.92 (2.13 - 11.40)< 0.0013.77 (1.50 - 9.49)0.005

 

Table 5. Univariate and Multivariate OR and 95% CI for Association of Postoperative Complications
 
Absence (n = 87)Complicate (n = 34)Univariate OR (95% CI)P-valueMultivariate OR (95% CI)†P-value
PNI: prognostic nutritional index; CEA: carcinoembryonic antigen; CA19-9: carbohydrate antigen 19-9; CRP: C-reactive protein; VFA: visceral fat area; BMI: body mass index; SMI: skeletal muscle mass index. †Model included age, sex and CA19-9.
Age (years)
  < 75582011
  ≥ 7529141.40 (0.62 - 3.17)0.4191.66 (0.67 - 4.13)0.274
Sex
  Female33711
  Male54272.36 (0.92 - 6.02)0.0732.80 (1.01 - 7.79)0.049
Stage
  Stage I-II52221
  Stage III33110.79 (0.34 - 1.83)0.580
Failure: 3
Disease
  Colorectal cancer59231
  Stomach cancer28111.01 (0.43 - 2.35)0.986
Charlson comorbidity index (points)
  ≤ 281281
  > 3662.89 (0.86 - 9.71)0.085
Histological type
  Undifferentiated921
  Differentiated78321.85 (0.38 - 9.02)0.449
CEA (ng/mL)
  < 650211
  ≥ 635110.75 (0.32 - 1.75)0.503
Failure: 4
CA19-9 (U/mL)
  < 37742411
  ≥ 37783.52 (1.16 - 10.74)0.0273.95 (1.24 - 12.64)0.021
Failure: 8
CRP (mg/dL)
  < 0.236131
  ≥ 0.237181.35 (0.58 - 3.15)0.491
Failure: 17
Albumin (g/dL)
  ≥ 3.550191
  < 3.525111.16 (0.48 - 2.80)0.745
Failure: 16
Hemoglobin (g/dL)
  ≥ male 11; female 1057201
  < male 11; female 1020101.43 (0.57 - 3.56)0.448
Failure: 14
HbA1c (%)
  < 6.552221
  ≥ 6.51261.18 (0.39 - 3.55)0.766
Failure: 29
PNI (points)
  ≥ 4058221
  < 401371.42 (0.50 - 4.02)0.510
Failure: 21
BMI (kg/m2)
  18.5 - 24.959221
  < 18.51481.53 (0.57 - 4.15)0.401
  ≥ 251440.77 (0.23 - 2.58)0.668
P for trend 0.313
SMI (kg/m2)
  ≥ male 6.25; female 5.1770221
  < male 6.25; female 5.1717122.25 (0.93 - 5.42)0.072
VFA (cm2)
  ≥ 100 cm243131
  < 100 cm242181.42 (0.62 - 3.25)0.410
Failure: 5
Body fat (%)
  ≥ male 30; female 42951
  < male 30; female 4278290.67 (0.21 - 2.16)0.502
Treatment technique
  Laparoscopic1751
  Laparotomy70291.41 (0.48 - 4.18)0.537
Chemotherapy
  Absence55221
  Prescription32120.94 (0.41 - 2.14)0.879

 

Table 6. Univariate and Multivariate OR and 95% CI for Association of Length of Stay
 
Short term (n = 55)Long term (n = 66)Univariate OR (95% CI)P-valueMultivariate OR (95% CI)†P-value
PNI: prognostic nutritional index; CEA: carcinoembryonic antigen; CA19-9: carbohydrate antigen 19-9; CRP: C-reactive protein; VFA: visceral fat area; BMI: body mass index; SMI: skeletal muscle mass index. †Model included age, sex, Charlson comorbidity index, albumin, SMI and treatment technique.
Age (years)
  < 75393911
  ≥ 7516271.69 (0.79 - 3.61)0.1781.15 (0.45 - 2.96)0.772
Sex
  Female192111
  Male36451.13 (0.53 - 2.42)0.7510.90 (0.35 - 2.31)0.825
Stage
  Stage I-II34401
  Stage III20241.02 (0.48 - 2.16)0.959
Failure: 3
Disease
  Colorectal cancer36461
  Stomach cancer19200.82 (0.38 - 1.77)0.619
Charlson comorbidity index (points)
  ≤ 2535611
  > 32104.73 (0.99 - 22.60)0.0515.73 (0.66 - 49.91)0.114
Histological type
  Undifferentiated561
  Differentiated50601.00 (0.29 - 3.47)1.000
CEA (ng/mL)
  < 632391
  ≥ 622240.90 (0.43 - 1.88)0.770
Failure: 4
CA19-9 (U/mL)
  < 3747511
  ≥ 374112.53 (0.76 - 8.51)0.132
Failure: 8
CRP (mg/dL)
  < 0.227221
  ≥ 0.218372.52 (1.14 - 5.59)0.023
Failure: 17
Albumin (g/dL)
  ≥ 3.5363311
  < 3.59273.27 (1.34 - 7.97)0.0093.07 (1.18 - 7.95)0.021
Failure: 16
Hemoglobin (g/dL)
  ≥ male 11; female 1035421
  < male 11; female 1012181.25 (0.53 - 2.95)0.610
Failure: 14
HbA1c (%)
  < 6.534401
  ≥ 6.58101.06 (0.38 - 2.99)0.909
Failure: 29
PNI (points)
  ≥ 4039411
  < 405152.85 (0.95 - 8.60)0.062
Failure: 21
BMI (kg/m2)
  18.5 - 24.941401
  < 18.57152.20 (0.81 - 5.95)0.122
  ≥ 257111.61 (0.57 - 4.57)0.370
P for trend 0.564
SMI (kg/m2)
  ≥ male 6.25; female 5.17464611
  < male 6.25; female 5.179202.22 (0.92 - 5.39)0.0781.63 (0.53 - 5.00)0.397
VFA (cm2)
  ≥ 100 cm224321
  < 100 cm231290.70 (0.34 - 1.46)0.343
Failure: 5
Body fat (%)
  ≥ male 30; female 424101
  < male 30; female 4251560.44 (0.13 - 1.49)0.186
Treatment technique
  Laparoscopic17511
  Laparotomy38615.46 (1.86 - 16.01)0.0023.72 (1.07 - 12.90)0.038
Chemotherapy
  Absence37401
  Prescription18261.34 (0.63 - 2.83)0.448