Visceral adipose tissue radiodensity measured by computed tomography is associated with increased desmoplastic reaction in colorectal tumors: a cohort study Body fat and desmoplasia in colorectal tumors

Abstract Understanding the interplay between adiposity and histopathological features of colorectal tumors is crucial for advancing strategies in disease management. We conducted a retrospective cohort study over an eight-year period (2007–2015), including patients who underwent surgical resection for colorectal cancer (CRC). Body composition was assessed via computed tomography (CT) at the level of the third lumbar vertebra, with visceral adipose tissue (VAT d ) and subcutaneous adipose tissue (SAT d ) radiodensities stratified into tertiles. Systemic inflammatory status was evaluated using the neutrophil-to-lymphocyte ratio (NLR). Logistic regression was employed to analyze the relationship between variables, using odds ratios (OR) with 95% confidence intervals (CI). The Cox proportional hazards model assessed hazard ratios (HRs) with 95% CIs. A total of 231 patients were included (48.9% men, 51.1% women), with 93.6% in CRC stages II and III. Multivariate analyses demonstrated that CRC stages II and III (OR = 5.15, 95% CI: 1.60–16.62; OR = 5.16, 95% CI: 1.59–16.77) and low VAT d (1st and 2nd tertiles; OR = 2.43, 95% CI: 1.30–4.53) were associated with the presence of desmoplasia. In the multivariate Cox analyses, only stage III disease (HR = 4.77, 95% CI: 1.09–20.89) and moderate to accentuated fibrous stroma (HR = 1.90, 95% CI: 1.03–3.46) were identified as predictors of reduced overall survival. These findings suggest that increased visceral adiposity may contribute to the development of a desmoplastic tumor microenvironment. Moreover, the presence of moderate to accentuated fibrous stroma is significantly associated with poorer long-term survival in patients with CRC.