Clinical impact of low bone mineral density in patients with colorectal cancer liver metastasis undergoing hepatectomy

TL;DR

Low bone density is linked to worse survival and more cancer recurrence in colorectal cancer patients who had liver surgery.

Contribution

This study identifies osteopenia as a significant prognostic factor for survival and recurrence in colorectal cancer liver metastasis patients.

Findings

Osteopenia is associated with shorter overall and recurrence-free survival in patients with colorectal cancer liver metastases.

Osteopenia increases the risk of lung metastases and is linked to reduced bone mineral density in patients with KRAS mutations.

Abstract

This study aimed to elucidate the clinical impact of osteopenia on the recurrence of colon cancer liver metastases.

Patients with colon cancer liver metastases (N = 186) undergoing hepatectomy at Jichi Medical University Hospital between March 2006 and March 2020 were examined retrospectively. Computed tomography (CT) scans on the 11th vertebra within 3 months of surgery assessed bone mineral density (BMD). Age-adjusted BMD determined osteopenia presence. Kaplan-Meier method with a log-rank test estimated survival. Factors associated with survival were assessed using Cox’s proportional hazards model after adjustment for confounders.

Patients with osteopenia had shorter overall (p = 0.0001; 5-year overall survival, 51.8% vs 81.8%) and recurrence-free survival (p = 0.0008, 5-year recurrence-free survival: 26.3% vs 51.5%) than BMD-normal patients. In multivariable analysis, the risk factor for overall survival was osteopenia (Hazard ratio (HR) 3.79, 95% confidence interval (CI) 2.09–6.87, p = 0.001). Risk factors for recurrence were chemotherapy (HR 1.92, 95%CI 1.12–3.30, p = 0.002), tumor number (HR 1.51, 95%CI 1.02–2.27, p = 0.04), and osteopenia (HR 2.18, 95%CI 1.46–3.24 p = 0.001). Patients with osteopenia are more likely to develop lung metastases, and BMD-value reduction associated with KRAS mutation.

Osteopenia may have prognostic significance in patients with liver metastases colorectal cancer.

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