L3 Skeletal Muscle Index on Preoperative Computed Tomography and Its Association with Clinical Outcomes in Patients with Colorectal Cancer
Keywords:
CT-defined sarcopenia, L3 skeletal muscle index, Colorectal cancer, Postoperative complications, Dual-energy computed tomographyAbstract
This retrospective prognostic study evaluated the prevalence of CT-defined sarcopenia and its association with postoperative outcomes in 170 colorectal cancer (CRC) patients undergoing surgical resection at Singburi Hospital during 2020-2024. Sarcopenia was assessed using the L3 skeletal muscle index (L3 SMI), which was measured from preoperative CT images using semi-automated segmentation. Sex-specific thresholds were applied: ≤38.89 cm²/m² for males and ≤33.28 cm²/m² for females. Outcomes included postoperative complications graded by the Clavien-Dindo classification, length of hospital stay (LOS), overall survival (OS), and disease-free survival (DFS). Survival was analyzed using the restricted mean survival time (RMST) at 60 months.
The results showed that the mean age was 66.6 ± 10.5 years, and 52.4% of patients were male. CT-defined sarcopenia was identified in 32.4% of the patients, with excellent intra-rater reliability (ICC = 0.984). Sarcopenic patients had significantly higher rates of Clavien-Dindo grade ≥2 (OR 2.53, 95% CI 1.26-5.08; p = 0.008) and grade ≥3 (OR 2.22, 95% CI 1.10-4.48; p = 0.024) complications. LOS and RMST for OS and DFS did not differ significantly between groups. BMI was the only baseline variable that differed significantly (19.6 ± 3.1 vs. 23.9 ± 4.6 kg/m²; p < 0.001).
In conclusion, CT-defined sarcopenia affects approximately one-third of Thai CRC patients and is associated with increased postoperative morbidity. L3 SMI measurement derived from routinely acquired preoperative CT may provide supplementary information for surgical risk assessment when considered alongside other clinical factors. Further validation is required before routine clinical use.
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