# 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.

## Key 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.