Frontiers in oncology · 2026
Preoperative CT-derived liver fat fraction and visceral adipose tissue index enhance postoperative recurrence risk stratification in colorectal cancer.
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Yin Ke, Wei Mei, Ba Wenjuan, Zhou Rongyu, Xiao Bo
Аннотация
BACKGROUND: Postoperative recurrence remains a major cause of treatment failure in colorectal cancer (CRC). We evaluated whether preoperative computed tomography (CT)-derived liver fat fraction (LFF) and visceral adipose tissue index (VATI) improve postoperative recurrence-risk prediction.
METHODS: This multi-cohort study included 525 patients after curative-intent surgery: a training cohort (n=260), external validation cohort (n=208), and exploratory prospective cohort (n=57). Candidate clinicopathologic and CT-derived variables were evaluated using Cox regression. Performance was assessed with Harrell C-index, time-dependent area under the receiver operating characteristic curve (AUC) at 12 and 24 months, calibration, decision curve analysis, and Kaplan-Meier analysis.
RESULTS: RFS events were observed in 129 patients. The final model included five predictors. N1-2 stage (hazard ratio [HR], 3.332; 95% confidence interval [CI], 1.807-6.145), elevated carbohydrate antigen 19-9 (CA19-9; HR, 2.414; 95% CI, 1.459-3.994), lymphovascular invasion (HR, 2.166; 95% CI, 1.250-3.752), VATI per 1-standard-deviation increase (HR, 1.519; 95% CI, 1.217-1.896), and LFF per 1-standard-deviation increase (HR, 2.228; 95% CI, 1.728-2.871) were independently associated with recurrence-free survival. C-indices were 0.851, 0.809, and 0.828 in the training, external, and prospective cohorts, respectively. Prospective 12- and 24-month AUCs were 0.759 (95% CI, 0.242-1.000) and 0.890 (95% CI, 0.709-1.000), with the latter based on only 20 evaluable patients. The combined validation cohort yielded a C-index of 0.813 and 12- and 24-month AUCs of 0.807 and 0.860.
CONCLUSION: CT-derived VATI and LFF improved risk stratification beyond routine clinicopathologic variables. The prospective findings remain exploratory and require confirmation in larger cohorts before clinical implementation.
METHODS: This multi-cohort study included 525 patients after curative-intent surgery: a training cohort (n=260), external validation cohort (n=208), and exploratory prospective cohort (n=57). Candidate clinicopathologic and CT-derived variables were evaluated using Cox regression. Performance was assessed with Harrell C-index, time-dependent area under the receiver operating characteristic curve (AUC) at 12 and 24 months, calibration, decision curve analysis, and Kaplan-Meier analysis.
RESULTS: RFS events were observed in 129 patients. The final model included five predictors. N1-2 stage (hazard ratio [HR], 3.332; 95% confidence interval [CI], 1.807-6.145), elevated carbohydrate antigen 19-9 (CA19-9; HR, 2.414; 95% CI, 1.459-3.994), lymphovascular invasion (HR, 2.166; 95% CI, 1.250-3.752), VATI per 1-standard-deviation increase (HR, 1.519; 95% CI, 1.217-1.896), and LFF per 1-standard-deviation increase (HR, 2.228; 95% CI, 1.728-2.871) were independently associated with recurrence-free survival. C-indices were 0.851, 0.809, and 0.828 in the training, external, and prospective cohorts, respectively. Prospective 12- and 24-month AUCs were 0.759 (95% CI, 0.242-1.000) and 0.890 (95% CI, 0.709-1.000), with the latter based on only 20 evaluable patients. The combined validation cohort yielded a C-index of 0.813 and 12- and 24-month AUCs of 0.807 and 0.860.
CONCLUSION: CT-derived VATI and LFF improved risk stratification beyond routine clinicopathologic variables. The prospective findings remain exploratory and require confirmation in larger cohorts before clinical implementation.