{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T23:11:03Z","timestamp":1783033863857,"version":"3.54.6"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100018736","name":"Kaken Pharmaceutical","doi-asserted-by":"publisher","award":["JP23K08139"],"award-info":[{"award-number":["JP23K08139"]}],"id":[{"id":"10.13039\/100018736","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>This study aimed to elucidate the clinical impact of osteopenia on the recurrence of colon cancer liver metastases.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Patients with colon cancer liver metastases (N\u2009=\u2009186) undergoing hepatectomy at Jichi Medical University Hospital between March 2006 and March 2020 were examined retrospectively. Computed tomography (CT) scans on the 11th vertebra within 3 months of surgery assessed bone mineral density (BMD). Age-adjusted BMD determined osteopenia presence. Kaplan-Meier method with a log-rank test estimated survival. Factors associated with survival were assessed using Cox\u2019s proportional hazards model after adjustment for confounders.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Patients with osteopenia had shorter overall (<jats:italic>p<\/jats:italic>\u2009=\u20090.0001; 5-year overall survival, 51.8% vs 81.8%) and recurrence-free survival (<jats:italic>p<\/jats:italic>\u2009=\u20090.0008, 5-year recurrence-free survival: 26.3% vs 51.5%) than BMD-normal patients. In multivariable analysis, the risk factor for overall survival was osteopenia (Hazard ratio (HR) 3.79, 95% confidence interval (CI) 2.09\u20136.87, <jats:italic>p<\/jats:italic>\u2009=\u20090.001). Risk factors for recurrence were chemotherapy (HR 1.92, 95%CI 1.12\u20133.30, <jats:italic>p<\/jats:italic>\u2009=\u20090.002), tumor number (HR 1.51, 95%CI 1.02\u20132.27, <jats:italic>p<\/jats:italic>\u2009=\u20090.04), and osteopenia (HR 2.18, 95%CI 1.46\u20133.24 <jats:italic>p<\/jats:italic>\u2009=\u20090.001). Patients with osteopenia are more likely to develop lung metastases, and BMD-value reduction associated with KRAS mutation.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Osteopenia may have prognostic significance in patients with liver metastases colorectal cancer.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0324719","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T17:34:56Z","timestamp":1750700096000},"page":"e0324719","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical impact of low bone mineral density in patients with colorectal cancer liver metastasis undergoing hepatectomy"],"prefix":"10.1371","volume":"20","author":[{"given":"Yuichi","family":"Aoki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2908-0177","authenticated-orcid":true,"given":"Atsushi","family":"Miki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasunaru","family":"Sakuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6637-9568","authenticated-orcid":true,"given":"Takehiro","family":"Kagaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makiko","family":"Tahara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9923-0305","authenticated-orcid":true,"given":"Takumi","family":"Teratani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Endo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Sasanuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8068-1277","authenticated-orcid":true,"given":"Wataru","family":"Nishimura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisanaga","family":"Horie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joji","family":"Kitayama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6689-5623","authenticated-orcid":true,"given":"Naohiro","family":"Sata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironori","family":"Yamaguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"issue":"9927","key":"pone.0324719.ref001","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1016\/S0140-6736(13)61649-9","article-title":"Colorectal 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