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Quantitative assessment of mesorectal fat: new prognostic biomarker in patients with mid-to-lower rectal cancer

 Jiyoung Yoon  ;  Yong Eun Chung  ;  Joon Seok Lim  ;  Myeong-Jin Kim 
 EUROPEAN RADIOLOGY, Vol.29(3) : 1240-1247, 2019 
Journal Title
Issue Date
Body Mass Index* ; Disease-Free Survival ; Female ; Humans ; Intra-Abdominal Fat/diagnostic imaging* ; Male ; Middle Aged ; Multidetector Computed Tomography/methods* ; Neoplasm Staging/methods* ; Prognosis ; Rectal Neoplasms/diagnosis* ; Rectum/diagnostic imaging*
Body mass index ; Colorectal neoplasms ; Digestive system surgical procedures ; Intra-abdominal fat
OBJECTIVES: To investigate the impact of mesorectal fat area (MFA) on oncologic outcomes in patients with mid-to-lower rectal cancer who received curative-intent surgery. METHODS: Patients with mid-to-lower rectal cancer who underwent preoperative abdominopelvic computed tomography (CT) and curative-intent surgery in 2011 were divided into two groups by tumour recurrence (group A) or no recurrence (group B) during a 5-year follow-up. Visceral fat area (VFA) and MFA were measured on preoperative CT and cutoff values were calculated using the Youden index. Univariate and multivariate regression analyses including BMI, VFA, and MFA were performed to investigate meaningful prognostic biomarkers. The Kaplan-Meier method with log-rank testing was used to validate prognostic biomarkers. RESULTS: Group A contained 42 patients and group B had 155 patients. Cutoff values were 25 kg/m2 for BMI, 130 cm2 for VFA, and 10 cm2 for MFA using the Youden index. On multivariate Cox regression analysis, MFA (odds ratio [OR] = 0.426, p = 0.010), TNM stage (p = 0.027), and perioperative complication grade (p = 0.028) were significantly different between groups. BMI and VFA did not show significant differences. By the Kaplan-Meier method with log-rank testing, disease-free survival (DFS) was significantly longer in patients with MFA ≥10 cm2 compared to patients with MFA <10 cm2 (p = 0.021), with no significant difference in overall survival (OS). CONCLUSIONS: MFA was an independent biomarker for predicting DFS in patients who underwent curative-intent surgery for mid-to-lower rectal cancer. KEY POINTS: • Mesorectal fat area is associated with the prognosis of rectal cancer patients. • Mesorectal fat area can be calculated easily in pre-operative CT scan. • Predicting prognosis of the cancer patient before operation is important.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Yoon, Jiyoung(윤지영)
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
Chung, Yong Eun(정용은) ORCID logo https://orcid.org/0000-0003-0811-9578
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