A Low Total Psoas Muscle Area Index Is a Strong Prognostic Factor in Metastatic Pancreatic Cancer

Abstract

Objectives:The total psoas area index (TPI) is an emerging alternative to the total skeletal muscle area index as a prognostic factor but has never been evaluated in metastatic pancreatic cancer (mPC).Methods: Areas were manually recorded, as previously described.Sex-specific cutoffs were identified by optimum stratification of TPI using log-rank χ 2 statistic associated with mortality to define sarcopenic psoas. Progression-free survival (PFS) and overall survival (OS) were the primary objectives. Two period groups were used as internal validation.Results: During the period study, 79 patients were treated for mPC. The TPI was correlated with PFS (hazards ratio, 0.81; P = 0.02) and OS (hazards ratio, 0.7; P < 0.001). Optimum thresholds defining sarcopenic psoas were less than 5.73 cm 2 /m 2 in men and less than 4.37 cm 2 /m 2 in women. Patients with sarcopenic psoas (62.0%) had shorter median PFS (2.9 months) compared with the others (6.6 months, adjusted P log-rank = 0.01), independently to the intensity of chemotherapy, weight loss, and performance status greater than 1. Similarly, OS was independently shorter in patients with sarcopenic psoas (7.6 months) versus the others (22.2 months, adjusted P < 0.001). These results were confirmed in the 2 period groups. Conclusions:A low TPI is a stronger independent prognostic factor in mPC.

Sarcopenia assessed by total psoas index – is it correlated with post-operative complications in all digestive cancers?

“…Of the secondary endpoints, sarcopenia defined by Dodson et al [9] was correlated to a higher risk of developing moderate or severe anemia at discharge, while sarcopenia defined by Williet et al [14] and by Xu et al…”

“…Williet at el. found TPAI to be a strong predictor of overall as well as progression-free survival in patients with metastatic pancreatic cancer [14]. Xu et al studied Chinese patients undergoing open pancreatoduodenectomy [15].…”

“…Another hypothesis is that most of the cut-off values that we evaluated were proposed for predicting mortality and not post-operative complications, since they were not all studied in patients undergoing surgery [11,13,14]. However, we might retaliate that our assessment included TPI values as a continuous variable as well as dichotomous, therefore if a significant correlation with post-operative complications existed, the ROC analysis would prove it.…”

“…[10], Kasahara et al [11], Kayano et al [12], Nakayama et al [13], Williet et al [14], Xu et al [15]) listed in table I.…”

“…Clear differentiation between muscles and surrounding tissue, completely visible muscle area without cuts, and lack of artifacts were the required criteria for the selected images to comply with quality indicators. Male patients (cm 2 /m 2 ) Cut-off 1 -Dodson et al [9] 3.38 4.77 Cut-off 2 -Jung et al [10] 4.43 8.18 Cut-off 3 -Kasahara et al [11] 2.07 2.49 Cut-off 4 -Kayano et al [12] 2.89 4.75 Cut-off 5 -Nakayama et al [13] 3.92 6.36 Cut-off 6 -Williet et al [14] 4.37 5.73 Cut-off 7 -Xu et al [15] 3.46 4.78…”