Table 1. Patients characteristics
Variables
|
All patients
|
|
(n=325)
|
Sex (male)
|
185 (57%)
|
Age (y)
|
76 (65-98)
|
BMI (kg/m2)
|
22.0 (12.1-34.2)
|
Hypertension
|
158 (49%)
|
Diabetes mellitus
|
84 (26%)
|
Cardiovascular disease
|
74 (23%)
|
ASA-PS ≥ 3
|
44 (14%)
|
Hemoglobin (g/dL)
|
11.2 (7.5-18.7)
|
Albumin (g/dL)
|
3.9 (1.8-5.0)
|
BMD (HU)
|
134 (58.8-265)
|
Osteopenia
|
115 (35%)
|
SMI (cm2 /m2)
|
43.7 (21.1-64.8)
|
Sarcopenia
|
186 (57%)
|
Osteosarcopenia
|
84 (26%)
|
Surgical approach (Laparoscopic)
|
203 (62%)
|
Tumor location (Rectum)
|
109 (34%)
|
Pathological T 4 stage
|
54 (17%)
|
Pathological N1/N2 stage
|
115 (35%)
|
Obstructive CRC
|
33 (9.2%)
|
Postoperative complication, yes
|
99 (30%)
|
Abbreviations: ASA-PS, American Society of Anesthesiologists physical status; BMD, Bone mineral density;
BMI, Body mass index; CAR/Alb ratio, C-reactive protein/albumin ratio; HU, Hounsfield unit;
NLR, Neutrophil to lymphocyte ratio; PNI, prognostic nutritional index; Skeletal muscle index, SMI
Table 2. Univariate and multivariate analyses of factors associated with disease-free survival
Variables
|
Univariate
|
Multivariate *
|
|
HR (95% CI)
|
P-value
|
HR (95% CI)
|
P-value
|
Age (≥ 80 years)
|
1.61 (1.06-2.43)
|
0.023
|
|
N.S
|
Sex (male)
|
1.45 (0.95-2.22)
|
0.087
|
1.65 (1.01-2.69)
|
0.045
|
ASA-PS ≥ 3
|
1.25 (0.71-2.21)
|
0.44
|
|
N.S
|
NLR (≥ 3.03)
|
2.17 (1.41-3.35)
|
<0.01
|
|
N.S
|
PNI (< 40)
|
2.03 (1.27-3.25)
|
<0.01
|
|
N.S
|
CRP/Alb ratio (≥ 0.070)
|
2.68 (1.73-4.14)
|
<0.01
|
2.12 (1.33-3.40)
|
<0.01
|
Osteopenia
|
2.86 (1.90-4.33)
|
<0.01
|
|
N.S
|
Sarcopenia
|
2.63 (1.65-4.21)
|
<0.01
|
|
N.S
|
Osteosarcopenia
|
3.83 (2.54-5.78)
|
<0.01
|
4.34 (2.66-7.08)
|
<0.01
|
Surgical approach (laparoscopic)
|
0.63 (0.41-0.94)
|
0.025
|
|
N.S
|
Tumor location (rectum)
|
1.25 (0.82-1.90)
|
0.31
|
|
N.S
|
Pathological T 4 stage
|
2.82 (1.80-4.42)
|
<0.01
|
1.84 (1.09-3.12)
|
0.023
|
Pathological N1/N2 stage
|
3.27 (2.16-4.95)
|
<0.01
|
2.44 (1.51-3.93)
|
<0.01
|
Obstructive CRC
|
2.25 (1.31-3.87)
|
<0.01
|
|
N.S
|
Serum CEA (≥ 5.0 ng/ml)
|
1.52 (0.98-2.35)
|
0.063
|
|
N.S
|
Serum CA19-9 (≥ 37 ng/ml)
|
1.64 (0.94-2.86)
|
0.082
|
|
N.S
|
Postoperative complication, yes
|
1.58 (1.04-2.41)
|
0.033
|
|
N.S
|
* The multivariable Cox regression model included age (≥ 80 vs. < 80 years), sex (male vs. female), ASA-PS (≥ 3 vs. < 3), NLR (≥ 3.03 vs. < 3.03), PNI (< 40 vs. ≥ 40), CRP/Alb ratio (≥ 0.070 vs. < 0.070), osteopenia (yes vs. no), sarcopenia (yes vs. no), osteosarcopenia (yes vs. no), surgical approach (laparoscopic vs. open), tumor location (rectum vs. colon), pathological T (T4 vs. T1-3), pathological N (positive vs. negative), obstructive CRC (yes vs. no), serum CEA (≥ 5.0 vs. < 5.0 ng/ml), serum CA19-9 (≥ 37 vs. < 37 U/ml) and postoperative complications (yes vs. no).
A backward elimination was conducted with a threshold P of 0.05 to select variables for the final models.
Abbreviations: CAR, C-reactive protein to albumin ratio; CA19-9, Carbohydrate antigen19-9;
CEA, Carcinoembryonic antigen; CI, confidence interval; CRC, colorectal cancer; HR, hazard ratio; NLR, Neutrophil to lymphocyte ratio; N.S, Not significant; PNI, prognostic nutritional index
Table 3. Univariate and multivariate analyses of factors associated with overall survival
Variables
|
Univariate
|
Multivariate *
|
|
HR (95% CI)
|
P-value
|
HR (95% CI)
|
P-value
|
Age (≥ 80 years)
|
2.89 (1.78-4.71)
|
<0.01
|
3.15 (1.76-5.64)
|
<0.01
|
Sex (male)
|
1.42 (0.86-2.34)
|
0.17
|
1.82 (1.00-3.30)
|
0.049
|
ASA-PS ≥ 3
|
1.84 (0.99-3.44)
|
0.056
|
|
N.S
|
NLR (≥ 3.03)
|
2.62 (1.57-4.36)
|
<0.01
|
|
N.S
|
PNI (< 40)
|
3.92 (2.36-6.49)
|
<0.01
|
|
N.S
|
CRP/Alb ratio (≥ 0.070)
|
3.63 (2.15-6.13)
|
<0.01
|
2.52 (1.42-4.50)
|
<0.01
|
Osteopenia
|
2.08 (1.29-3.36)
|
<0.01
|
|
N.S
|
Sarcopenia
|
2.92 (1.66-5.13)
|
<0.01
|
|
N.S
|
Osteosarcopenia
|
2.83 (1.75-4.58)
|
<0.01
|
2.79 (1.55-5.03)
|
<0.01
|
Surgical approach (laparoscopic)
|
0.66 (0.40-1.06)
|
0.087
|
|
N.S
|
Tumor location (rectum)
|
0.90 (0.54-1.50)
|
0.69
|
|
N.S
|
Pathological T 4 stage
|
3.53 (2.13-5.86)
|
<0.01
|
1.92 (1.04-3.52)
|
0.036
|
Pathological N1/N2 stage
|
3.01 (1.85-4.90)
|
<0.01
|
2.19 (1.25-3.85)
|
<0.01
|
Obstructive CRC
|
2.28 (1.22-4.27)
|
<0.01
|
|
N.S
|
Serum CEA (≥ 5.0 ng/ml)
|
1.25 (0.73-2.12)
|
0.41
|
|
N.S
|
Serum CA19-9 (≥ 37 ng/ml)
|
2.88 (1.61-5.15)
|
<0.01
|
2.00 (1.03-3.90)
|
0.041
|
Postoperative complication, yes
|
1.51 (0.93-2.47)
|
0.099
|
|
N.S
|
* The multivariable Cox regression model included age (≥ 80 vs. < 80 years), sex (male vs. female), ASA-PS (≥ 3 vs. < 3), NLR (≥ 3.03 vs. < 3.03), PNI (< 40 vs. ≥ 40), CRP/Alb ratio (≥ 0.070 vs. < 0.070), osteopenia (yes vs. no), sarcopenia (yes vs. no), osteosarcopenia (yes vs. no), surgical approach (laparoscopic vs. open), tumor location (rectum vs. colon), pathological T (T4 vs. T1-3), pathological N (positive vs. negative), obstructive CRC (yes vs. no), serum CEA (≥ 5.0 vs. < 5.0 ng/ml), serum CA19-9 (≥ 37 vs. < 37 U/ml) and postoperative complications (yes vs. no).
A backward elimination was conducted with a threshold P of 0.05 to select variables for the final models.
Abbreviations: CAR, C-reactive protein to albumin ratio; CA19-9, Carbohydrate antigen19-9;
CEA, Carcinoembryonic antigen; CI, confidence interval; CRC, colorectal cancer; HR, hazard ratio; NLR, Neutrophil to lymphocyte ratio; N.S, Not significant; PNI, prognostic nutritional index
Table 4. Patients characteristics according to osteosarcopenia
Variables
|
Osteosarcopenia
|
Non-osteosarcopenia
|
P-value
|
|
(n=84)
|
(n=241)
|
|
Age (y)
|
77 (65-93)
|
76 (65-98)
|
0.86
|
Sex (male)
|
42 (50%)
|
143 (59%)
|
0.16
|
BMI (kg/m2)
|
20.3 (13.2-34.2)
|
22.4 (12.1-32.4)
|
<0.01
|
Hypertension
|
34 (40%)
|
124 (51%)
|
0.099
|
Diabetes mellitus
|
19 (23%)
|
65 (27%)
|
0.47
|
Cardiovascular disease
|
20 (24%)
|
54 (22%)
|
0.77
|
ASA-PS ≥ 3
|
13 (15%)
|
31 (13%)
|
0.58
|
Hemoglobin (g/dL)
|
11.5 (8.1-16.8)
|
12.1 (7.5-18.7)
|
0.057
|
Albumin (g/dL)
|
3.8 (1.9-4.8)
|
3.9 (1.9-5.0)
|
0.057
|
NLR
|
2.76 (0.85-7.00)
|
2.59 (0.35-6.64)
|
0.071
|
PNI
|
45.7 (22.1-58.4)
|
47.2 (24.9-63.2)
|
0.031
|
CRP/Alb ratio
|
0.079 (0.004-1.97)
|
0.054 (0.002-1.90)
|
0.33
|
BMD (HU)
|
96.1 (58.9-142.4)
|
149 (58.8-265)
|
<0.01
|
Osteopenia
|
84 (100%)
|
31 (13%)
|
<0.01
|
SMI (cm2 /m2)
|
37.4 (21.1-43.6)
|
43.2 (23.4-64.9)
|
<0.01
|
Sarcopenia
|
84 (100%)
|
102 (42%)
|
<0.01
|
Surgical approach (Laparoscopic)
|
46 (55%)
|
157 (65%)
|
0.12
|
Tumor location (Rectum)
|
32 (38%)
|
77 (32%)
|
0.35
|
Pathological T 4 stage
|
22 (26%)
|
32 (13%)
|
0.010
|
Pathological N1/N2 stage
|
39 (46%)
|
76 (32%)
|
0.017
|
Obstructive CRC
|
15 (18%)
|
18 (7.4%)
|
0.011
|
Postoperative complication, yes
|
36 (43%)
|
63 (26%)
|
<0.01
|
Abbreviations: ASA-PS, American Society of Anesthesiologists physical status; BMD, Bone mineral density;
BMI, Body mass index; CAR/Alb ratio, C-reactive protein/albumin ratio; CRC, colorectal cancer;
HU, Hounsfield unit; NLR, Neutrophil to lymphocyte ratio; PNI, prognostic nutritional index;
Skeletal muscle index, SMI