Gain of visceral adipose tissue rather than low skeletal muscle mass is associated with overall survival in patients with colorectal liver metastases; results from the NewEPOC study
Gain of visceral adipose tissue rather than low skeletal muscle mass is associated with overall survival in patients with colorectal liver metastases; results from the NewEPOC study
Introduction: sarcopenia and adiposity at diagnosis are important prognostic factors in cancer. Ongoing changes in body composition during chemotherapy treatment may have additional prognostic relevance. This study aimed to investigate the association between body composition changes during neoadjuvant treatment and survival in patients with colorectal liver metastases.
Materials and methods: in this subgroup analysis of the newEPOC RCT (NCT00482222), pre- and post-treatment CT-scans of patients undergoing neoadjuvant chemotherapy for colorectal liver metastases were studied. The total cross-sectional area of skeletal muscle tissue (SM), Visceral Adipose Tissue (VAT), Subcutaneous Adipose Tissue (SAT), Intra-Muscular Adipose Tissue (IMAT), and radiation attenuation for skeletal muscle (SM-RA) were determined.
Results: during neoadjuvant therapy, SM-index decreased from 50.6 ± 8.7 to 47.6 ± 8.6 cm2/m2, p < 0.001 for men and 40.5 ± 6.1 to 37.7 ± 5.9 cm2/m2, p = 0.002, for women. SM-RA decreased from 37.7 ± 7.8 to 36.0 ± 7.6 HU, p < 0.001 for men. VAT- and SAT-indices did not change significantly during treatment. Sarcopenia, SM-loss, SM-RA as baseline as well as change in SM-RA were not associated with overall survival, while intervention arm (HR1.96, 95 %CI1.21-3.19, p = 0.009), undergoing resection of the metastases (HR0.19, 95 %CI0.09-0.40, p < 0.001) and gaining >2 % VAT-index over 12 weeks (HR2.05, 95 %CI1.12-3.76, p = 0.025) were.
Conclusions: the body composition features SM and SM-RA decreased during chemotherapy, but were not associated with survival. On the contrary, although VAT did not significantly change, the gain of VAT was an independent prognostic factor for survival. These results should be validated in independent cohorts but may indicate that in this selected patient group, adipose tissue might be a more important prognostic factor than sarcopenia.
Body composition, Cachexia, Cancer, Colorectal liver metastases, Prognosis
Aberle, Merel R.
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Ligthart, Marjolein A.P.
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West, Malcolm A.
98b67e58-9875-4133-b236-8a10a0a12c04
Rensen, Sander S.
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Eminton, Zina
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van Dijk, David P.J.
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Pugh, Sian A.
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Bridgewater, John A.
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Primrose, John N.
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Olde Damink, Steven W.M.
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27 November 2026
Aberle, Merel R.
dd5424b0-3be8-465f-8e4b-42a5ae5b3c77
Ligthart, Marjolein A.P.
11082169-9e97-4fd8-b3eb-3213292b2a37
West, Malcolm A.
98b67e58-9875-4133-b236-8a10a0a12c04
Rensen, Sander S.
5d809235-a5ee-48d9-804e-89f711ee7e07
Eminton, Zina
44904d98-97be-4080-9a84-bf5742525f8e
van Dijk, David P.J.
6e67c1e2-ca01-454d-bbee-fc0f7ff3f56f
Pugh, Sian A.
7c46dc51-7cee-4914-8dc6-df31fc66e16e
Bridgewater, John A.
22a97d4c-b9df-4f88-b413-d3193d2d14b7
Primrose, John N.
d85f3b28-24c6-475f-955b-ec457a3f9185
Olde Damink, Steven W.M.
504fcca4-2739-494f-a203-70f0d756d3f7
Aberle, Merel R., Ligthart, Marjolein A.P., West, Malcolm A., Rensen, Sander S., Eminton, Zina, van Dijk, David P.J., Pugh, Sian A., Bridgewater, John A., Primrose, John N. and Olde Damink, Steven W.M.
(2026)
Gain of visceral adipose tissue rather than low skeletal muscle mass is associated with overall survival in patients with colorectal liver metastases; results from the NewEPOC study.
European Journal of Surgical Oncology, 52 (1), [111179].
(doi:10.1016/j.ejso.2025.111179).
Abstract
Introduction: sarcopenia and adiposity at diagnosis are important prognostic factors in cancer. Ongoing changes in body composition during chemotherapy treatment may have additional prognostic relevance. This study aimed to investigate the association between body composition changes during neoadjuvant treatment and survival in patients with colorectal liver metastases.
Materials and methods: in this subgroup analysis of the newEPOC RCT (NCT00482222), pre- and post-treatment CT-scans of patients undergoing neoadjuvant chemotherapy for colorectal liver metastases were studied. The total cross-sectional area of skeletal muscle tissue (SM), Visceral Adipose Tissue (VAT), Subcutaneous Adipose Tissue (SAT), Intra-Muscular Adipose Tissue (IMAT), and radiation attenuation for skeletal muscle (SM-RA) were determined.
Results: during neoadjuvant therapy, SM-index decreased from 50.6 ± 8.7 to 47.6 ± 8.6 cm2/m2, p < 0.001 for men and 40.5 ± 6.1 to 37.7 ± 5.9 cm2/m2, p = 0.002, for women. SM-RA decreased from 37.7 ± 7.8 to 36.0 ± 7.6 HU, p < 0.001 for men. VAT- and SAT-indices did not change significantly during treatment. Sarcopenia, SM-loss, SM-RA as baseline as well as change in SM-RA were not associated with overall survival, while intervention arm (HR1.96, 95 %CI1.21-3.19, p = 0.009), undergoing resection of the metastases (HR0.19, 95 %CI0.09-0.40, p < 0.001) and gaining >2 % VAT-index over 12 weeks (HR2.05, 95 %CI1.12-3.76, p = 0.025) were.
Conclusions: the body composition features SM and SM-RA decreased during chemotherapy, but were not associated with survival. On the contrary, although VAT did not significantly change, the gain of VAT was an independent prognostic factor for survival. These results should be validated in independent cohorts but may indicate that in this selected patient group, adipose tissue might be a more important prognostic factor than sarcopenia.
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PIIS0748798325016075
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Accepted/In Press date: 7 November 2025
e-pub ahead of print date: 19 November 2025
Published date: 27 November 2026
Keywords:
Body composition, Cachexia, Cancer, Colorectal liver metastases, Prognosis
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Local EPrints ID: 508212
URI: http://eprints.soton.ac.uk/id/eprint/508212
ISSN: 0748-7983
PURE UUID: 38f1c809-62f6-4281-b6a3-d2b2e0f0e791
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Date deposited: 14 Jan 2026 17:54
Last modified: 15 Jan 2026 02:52
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Author:
Merel R. Aberle
Author:
Marjolein A.P. Ligthart
Author:
Sander S. Rensen
Author:
Zina Eminton
Author:
David P.J. van Dijk
Author:
Sian A. Pugh
Author:
John A. Bridgewater
Author:
Steven W.M. Olde Damink
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