Annals of gastroenterological surgery · 2026
Prognostic Value of Psoas Major Muscle Volume in Assessing Sarcopenia in Elderly Patients With Rectal Cancer.
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Tsujio Gen, Manabe Shoichi, Shiomi Akio, Tanaka Yusuke, Kasai Shunsuke, Kojima Tadahiro, Igaki Takahiro, Mori Yukihiro, Notsu Akifumi
Аннотация
BACKGROUND: This study aimed to evaluate the clinical utility and prognostic significance of sarcopenia classification based on the psoas major muscle volume index (PVI) in elderly patients with rectal cancer.
METHODS: We retrospectively analyzed 428 patients aged ≥ 65 years who underwent laparoscopic or robot-assisted radical rectal cancer resection between 2014 and 2018. PVI was calculated by dividing the semi-automatically measured psoas major muscle volume on three-dimensional computed tomography (CT) by the cube of height (m3). Sex-specific PVI cutoff values for 5-year overall survival (OS) were determined using time-dependent receiver operating characteristic analysis. Associations between PVI, nutritional and inflammatory markers, conventional sarcopenia indices, and long-term outcomes were investigated.
RESULTS: PVI cut-off values were ≤ 58.9 cm3/m3 for males and ≤ 39.9 cm3/m3 for females. Patients with low PVI had significantly worse nutritional and inflammatory profiles. The 5-year OS (86.6% vs. 94.6%, p = 0.001), cancer-specific survival (93.5% vs. 97.4%, p = 0.003), and relapse-free survival (76.2% vs. 85.4%, p = 0.021) were significantly lower in the low PVI group than in the normal-high PVI group. Multivariate analysis identified low PVI (hazard ratio: 2.55; p = 0.012) and Prognostic Nutritional Index < 40 as independent predictors of poor OS.
CONCLUSION: PVI-based sarcopenia classification reflects nutritional and inflammatory status and enables effective prognostic stratification in elderly patients with rectal cancer. It may serve as a simple and objective tool for preoperative risk assessment, offering improved prognostic stratification compared with conventional CT-based indices.
METHODS: We retrospectively analyzed 428 patients aged ≥ 65 years who underwent laparoscopic or robot-assisted radical rectal cancer resection between 2014 and 2018. PVI was calculated by dividing the semi-automatically measured psoas major muscle volume on three-dimensional computed tomography (CT) by the cube of height (m3). Sex-specific PVI cutoff values for 5-year overall survival (OS) were determined using time-dependent receiver operating characteristic analysis. Associations between PVI, nutritional and inflammatory markers, conventional sarcopenia indices, and long-term outcomes were investigated.
RESULTS: PVI cut-off values were ≤ 58.9 cm3/m3 for males and ≤ 39.9 cm3/m3 for females. Patients with low PVI had significantly worse nutritional and inflammatory profiles. The 5-year OS (86.6% vs. 94.6%, p = 0.001), cancer-specific survival (93.5% vs. 97.4%, p = 0.003), and relapse-free survival (76.2% vs. 85.4%, p = 0.021) were significantly lower in the low PVI group than in the normal-high PVI group. Multivariate analysis identified low PVI (hazard ratio: 2.55; p = 0.012) and Prognostic Nutritional Index < 40 as independent predictors of poor OS.
CONCLUSION: PVI-based sarcopenia classification reflects nutritional and inflammatory status and enables effective prognostic stratification in elderly patients with rectal cancer. It may serve as a simple and objective tool for preoperative risk assessment, offering improved prognostic stratification compared with conventional CT-based indices.