Sarcopenic Obesity in Patients Undergoing Colorectal Liver Metastases (CRLM) Resection

Introduction: Sarcopenia is used surrogate for the frailty syndrome and was proven as prognostic for worse outcome after CRLM resection. In case of obesity sarcopenia is a metabolic double burden for the patients promoting worse outcomes and disease progression. We aimed to compare sarcopenia and sarcopenic obesity in patients undergoing CRLM resection along with established prognostic parameters such as KRAS status, TNM classification or the patients` individual inflammatory response. Methods: Sarcopenia was defined using the skeletal muscle index (SMI) with gender specific cut off values (48.4 cm2/m2 in females and 59.1 cm2/m2 in males) by measuring the preoperative muscle mass of patients at the height L3 with OSIRIX DICOM viewer. SO was derived as the presence of sarcopenia and obesity with obesity being defined using body fat percentages. Both parameters were evaluated along with established prognostic factors like KRAS status, TNM classification and inflammatory response parameters. Results: 251 patients (median age 68 years, 62% females) were included. Risk of death of sarcopenic patients was 3 times higher as compared to non sarcopenic (HR 3.41, CI95% 1.67-5.43, p=0.04), however SO patients’ risk was even 5 times higher (HR 5.4, CI95% 2.45-7.65, p=0.01). COX regression analysis revealed SO along with KRAS positivity as independent predictor for disease free survival (SO: p=0.038, KRAS: p=0.041; TNM, age, tumor size, CCI, PLR, NLR: all not significant). Patients`risk of death in case of KRAS positivity and SO was even 7 times higher (HR 7.35, CI95% 4.51-10.34; p=0.003). Discussion: There seems to be a benefit in merging data on mutational status and muscle wasting in patients with CRLM in order to facilitate an individual patient tailored approach.