What question did this study set out to answer?

To assess how CT-derived body composition metrics and clinical factors impact prognosis in stage II rectal cancer patients.

April 22, 2026Open Access

Decoding the association between CT-derived body composition metrics and prognosis in stage II rectal cancer

FJFengli JiangShenyang Agricultural University ZWZiyan WengTianjin University of Technology ZSZhiqing ShaoZhejiang Cancer Hospital

Puntos clave

To assess how CT-derived body composition metrics and clinical factors impact prognosis in stage II rectal cancer patients.
Analyzed data from stage II rectal cancer patients post-radical surgery
Developed a prognostic model using a Cox proportional hazards model
Validated the nomogram based on various clinical and body composition factors
183 deaths recorded during a median follow-up of 53 months
Low skeletal muscle density and high visceral-to-subcutaneous adipose ratio identified as significant risk factors
Nomogram showed superior predictive performance with AUC values of up to 0.77 for overall survival at 1-year

Resumen

Abstract Objectives To evaluate the prognostic impact of CT-derived body composition metrics and clinical factors, and to develop a prognostic model in patients with stage II rectal cancer. Materials and methods This retrospective study analyzed consecutive stage II rectal cancer patients who underwent radical surgery. The predictive value of body composition metrics and clinical factors was evaluated. A Cox proportional hazards model-derived nomogram, based on independent risk factors identified through univariate and multivariate analyses, was established and validated to predict overall survival (OS). Results Among 975 patients (median age 63 years, IQR 55–70 years; 644 66.1% males), 183 deaths were recorded during a median follow-up period of 53 months (IQR 33–83 months). Low skeletal muscle density (SMD) (OR = 0.43; 95% CI: 0.20, 0.91), age ≥ 65 years, and CA125 positive ( p 24.9, and T4 stage ( p < 0.05) were risk factors for prolonged hospitalization. After univariate and multivariate analyses, the nomogram based on age, gross type, perineural invasion, lymphovascular invasion, inflammatory burden index, subcutaneous fat area (SFA), and SMD ( p < 0.05) exhibited area under the curve values of 0.77/0.62, 0.77/0.62, and 0.75/0.67 at 1-year, 3-year, and 5-year OS in training/validation sets, respectively. Conclusions In predicting the prognosis of stage II rectal cancer patients, VSR, SFA, and SMD were superior to other body composition metrics. The nomogram integrating body composition metrics and clinical factors showed superior predictive performance for OS compared to a single risk factor alone. Critical relevance statement CT-derived body composition metrics can predict the prognosis of rectal cancer patients by reflecting the nutritional and metabolic status. Key Points Body composition metrics’ prognostic utility in stage II rectal cancer is clear. Body composition metrics are associated with clinical outcomes in stage II rectal cancer. Body composition is a predictive biomarker for stage II rectal cancer. Graphical Abstract

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