Co-occurrence of CT-based radiological sarcopenia and frailty are related to impaired survival in surgical oncology

Objectives The objective of this study was to investigate the association of radiological sarcopenia and frailty with postoperative outcomes in adult patients undergoing oncological surgery. Methods Data were derived from the PICNIC study, consisting of two consecutive series of patients undergoing surgical cancer treatment. Radiological sarcopenia was assessed based on CT imaging. The presence of low muscle mass and/or low muscle density was determined based on lowest quartile gender specific cut-off values. Frailty was defined by a score of >= 4 on the Groningen frailty index. Postoperative overall survival was analysed with Kaplan-Meier curves and Logrank testing. Multivariable Cox regression analyses adjusted for age and gender were performed to calculate adjusted hazard ratios (HR). Results A total of 372 patients were included. Median age was 69 (28-86) years, 77 patients (23.5%) were frail and radiological sarcopenia was present in 134 patients (41.0%). Combined radiological sarcopenia and frailty was present in 35 patients (10.7%). One-year (65.6% versus 87.0%) and three-year survival (31.4% versus 66.8%) were significantly worse in patients with combined radiological sarcopenia and frailty. The combined presence of radiological sarcopenia and frailty was associated with significantly decreased overall survival (HRadjusted: 2.06, 95% CI: 1.39-3.05, P < .001). Conclusion Co-occurrence of radiological sarcopenia and frailty is strongly related to impaired survival in surgical cancer patients. Advances in knowledge The combined presence of radiological sarcopenia and frailty is associated with decreased postoperative survival, strongly exceeding the effects of both risk factors separately. The use of radiological sarcopenia in addition to frailty screening can further optimize preoperative risk stratification.