Effect of low visceral fat area on long-term survival of stage I–III colorectal cancer

The prognostic significance of a low visceral fat area (VFA) in colorectal cancer (CRC) remains unclear. Hence, we evaluated the prognostic impact of a low VFA on the long-term outcomes of patients with CRC after laparoscopic surgery. Totally, 306 patients with stages I–III CRC who underwent R0 resection were included in this retrospective study. VFA was preoperatively measured via computed tomography using image processing software. Relapse-free survival (RFS) and overall survival (OS) rates were analyzed using the Cox proportional hazards model and Kaplan–Meier curves. Low VFA was identified in 153 patients. The low-VFA group had significantly lower RFS and OS rates than did the high-VFA group (5-year RFS rates: 72.1% versus 88.6%, p=0.0002; 5-year OS rates: 71.5% versus 92.2%, p=0.0001). The independent significant predictors of RFS were T3 or T4 disease (hazard ratio [HR]: 2.75, 95% confidence interval [CI]: 1.12–6.76, p=0.027), stage III CRC (HR: 3.49, 95%CI:1.82–6.69, p<0.001), low psoas muscle index (PMI) (HR: 2.12, 95%CI: 1.19–3.79, p=0.011), and low VFA (HR: 2.12, 95%CI: 1.16–3.86, p=0.014). The independent significant predictors of OS were age ≥65 years (HR: 2.59, 95%CI: 1.13–5.92, p=0.024), carbohydrate antigen 19-9 levels ≥37.0 ng/mL (HR: 2.32, 95%CI: 1.18–4.58, p=0.015), stage III CRC (HR: 2.66, 95%CI: 1.37–5.17, p=0.004), low PMI (HR: 2.00, 95%CI: 1.06–3.77, p=0.031), and low VFA (HR: 2.42, 95%CI: 1.24–4.70, p=0.009). A low preoperative VFA was significantly associated with worse RFS and OS rates in patients who underwent CRC resection.