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Sarcopenia is associated with low muscle mass and low physical performance. Here, we performed to evaluate the sarcopenia as prognostic factor and treatment outcomes in older patients with locally advanced rectal cancer (LARC) who received preoperative or postoperative chemoradiotherapy (CRT).LARC patients aged ≥65 years who received either preoperative or postoperative CRT were analyzed retrospectively. Preoperative or postoperative CRT consisted of 50.4 Gy and fluoropyrimidine. Surgery was performed at 6 weeks after CRT completion. Postoperative CRT was performed at 4 weeks after surgery. One month after surgery or CRT, adjuvant chemotherapy was given. Overall survival (OS) and disease free survival (DFS), local recurrence (LR), and prognostic factor were evaluated.Thirty patients received preoperative CRT and 35 patients received postoperative CRT. Five-year OS rate, 5-year DFS rate, or 5-year LR rate was not significantly different between preoperative and postoperative CRT groups (69.0%, 58.5%, and 3.4% vs 73.6%, 67.9%, and 6.9%, P = .56, P = .37, and P = .77, respectively). Age, sex, stage, CEA level, or timing of CRT did not affect OS. However, 5-year OS rate of patients with sarcopenia was significantly lower than those without sarcopenia (38.0% vs 92.5%, P < .001). Multivariate analysis showed that sarcopenia was the only independent prognostic factor for overall survival (OS) (hazard ratio [HR]: 6.08, P = .001).There was no difference in survival between preoperative CRT and postoperative CRT in older patients with LARC. Sarcopenia is a poor prognostic factor in older patients with LARC who received preoperative or postoperative CRT.