Clusters of Anthropometric Features in Colorectal Cancer Patients with Synchronous Metastases and Their Association with Overall Survival and RAS Mutation

Background: Anthropometric traits—such as height, body mass index (BMI), and age—are shaped by genetic, nutritional, and environmental factors, which may also be influential in colorectal cancer (CRC). We investigated whether sex-adjusted variations in these parameters could be associated with different subtypes of CRC and overall survival outcomes. Methods: We analyzed patients with synchronous metastatic CRC enrolled in the prospective BMI-QoL study (NCT03873064). Age, height, and BMI were standardized and subjected to k-means clustering (k = 2, 25 random initializations). Principal component analysis was used to visualize cluster separation in two dimensions. “Core cluster members” were defined using sex-specific cutoffs for all three variables, excluding borderline cases. Difference in Overall survival (OS) between clusters was assessed using Kaplan–Meier and Cox proportional hazards models; clinical and molecular features were compared using chi-square and Mann–Whitney tests. Results: Two reproducible clusters emerged. Cluster 1 comprised younger, taller, normal-to-overweight patients; Cluster 2 included older, shorter, underweight patients. Core cluster 1 members (n = 23) had significantly longer OS than core cluster 2 members (n = 31) (median OS 51.1 vs. 22.0 months; HR 2.28, p = 0.03), with survival curves diverging beyond 24 months. Non-core members had intermediate OS (median 31 months). Age, height, and BMI individually were not significant OS predictors. RAS wild-type tumors were more prevalent in core cluster 1 (61%) than core cluster 2 (32%, p = 0.03). CEA levels and metastatic patterns did not differ between clusters. Conclusion: Sex-adjusted anthropometric profiling identifies two prognostically distinct mCRC subtypes. The association of better survival with higher BMI, younger age and taller stature—alongside increased prevalence of RAS wild-type tumors—supports the biological relevance of these profiles. Larger prospective validation integrating anthropometric and genomic data is warranted