The Prognostic Impact of Sarcopenia in Stage I to III Colon Cancer A Retrospective Study

Background Colon cancer (CC) is a common malignancy, and while the TNM staging system is extensively used for prognostic, it has limitations in predicting individual outcomes. In recent years, Sarcopenia has emerged as a significant prognostic factor in cancer patients. This study aimed to investigate the prognostic value of sarcopenia in stage I–III colon cancer patients. Methods This retrospective analysis included 230 CC patients who underwent tumor resection at the Second Hospital of Lanzhou University. Preoperative abdominal computed tomography (CT) scans were used to assess the skeletal muscle index (SMI). Patients were categorized into sarcopenia and non-sarcopenia groups based on the SMI. The primary outcome was overall survival (OS). The prognostic role of sarcopenia was assessed using Kaplan-Meier survival curves, Cox regression modeling and time-dependent Receiver Operator Characteristic (ROC) analysis. In addition, a combined TNM- sarcopenia model was developed. Results Among the 230 patients, 24.34% were diagnosed with sarcopenia. Kaplan-Meier curves showed that patients in the sarcopenia group had significantly lower OS compared to the non-sarcopenia group (P < 0.001). Cox regression identified sarcopenia as an independent adverse prognostic factor (HR, 1.70, 95%CI: 1.05–2.75). Incorporating sarcopenia into the TNM model increased the C-index from 0.570 to 0.604 (P _{likelihood ratio} = 0.027), with improved predictive performance at 1-year, 3-year, and 5-year time points. Conclusion Sarcopenia is not only an independent prognostic factor for OS in patients with stage I–III CC, but also serves as a valuable supplement to existing prognostic assessment tools, which may contribute to personalized treatment strategies.