Prognostic Impact of Preoperative SARC-F Score on Cancer-Specific Survival in Patients with Colorectal Cancer

Background Sarcopenia adversely affects outcomes in patients with colorectal cancer (CRC); however, the prognostic significance of functional sarcopenia screening tools such as the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire remains unclear. Objective This study aimed to evaluate the prognostic impact of preoperative SARC-F scores on oncologic outcomes in patients with CRC. Methods We retrospectively analyzed 219 patients who underwent curative resection for CRC and completed the SARC-F questionnaire preoperatively between July 2019 and June 2021. Patients with a SARC-F score ≥ 4 were classified into the high SARC-F group. Results Of the 219 patients, 26 (11.9%) had high SARC-F scores. Compared with the low SARC-F group, patients with high SARC-F scores were older, more frequently female, had lower body mass index, a higher prevalence of diabetes mellitus, more right-sided tumors, and elevated preoperative C-reactive protein and neutrophil-to-lymphocyte ratio levels (all p  < 0.05). Pathologic characteristics were comparable between groups, except for a higher number of retrieved lymph nodes in the high SARC-F group ( p  = 0.033). Overall survival and cancer-specific survival were significantly lower in the high SARC-F group (OS: 82.9% vs. 92.0%, p  = 0.036; CSS: 88.5% vs. 96.9%, p  = 0.011), whereas disease-free survival did not differ significantly. In multivariate analysis, a SARC-F score ≥ 4 independently predicted poorer cancer-specific survival ( p  = 0.032), while higher body mass index was associated with improved overall survival, and left-sided tumor location and lymphovascular invasion were independent predictors of disease-free survival. Conclusions A high preoperative SARC-F score is independently associated with inferior cancer-specific survival in patients with CRC, highlighting the prognostic relevance of functional impairment. The SARC-F questionnaire may serve as a simple and clinically feasible tool for preoperative risk stratification in colorectal cancer.