Can pancreatic cancer behavior be predicted based on computed tomography measurements of fat and muscle mass?

Abstract

Introduction: Many studies purport that obesity, and specifically visceral fat, impact survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. However, these studies involve crude measures of obesity [eg, body mass index (BMI)] or visceral fat [eg, linear measurements on computed tomographic (CT) scans]. Some studies purport that weight loss and muscle wasting (ie, sarcopenia) presage poor survival in these patients. This study was undertaken to accurately measure and reexamine the impact of visceral fat, subcutaneous fat, and sarcopenia on pancreatic cancer. Materials and methods: CT scans of 100 patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma were reviewed using specialized software to precisely determine the cross-sectional area (CSA) of subcutaneous fat, visceral fat, and psoas muscles at the level of L5 vertebra. In addition, linear measurements of subcutaneous fat and visceral fat were undertaken. Measures of cancer progression included tumor (T) status, nodal (N) status, American Joint Committee on Cancer stage, and overall survival after resection. Regression analysis was utilized, with and without standardization of all measurements to body size. Median data are presented. Results: The median patient age was 67 years, with a BMI of 24 kg/m 2 . Cancer stage was IIB for 60% of patients. BMI, CSA of visceral fat, CSA for subcutaneous fat, CSA for psoas muscles, and linear measurements of visceral and subcutaneous fat were not significantly related to any measures of cancer progression or survival. Standardization to body size did not demonstrate any relationships with cancer progression or survival. Conclusions: Precise and reproducible measures of visceral fat, subcutaneous fat, and muscle mass, even when standardized to body size, do not predict cancer progression or survival in patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma. Pancreatic cancer biology and behavior is too complex to predict with a CT scanner. The main focus of pancreatic cancer research should continue to be at the molecular, genetic, and immunologic levels.

<p>L3 skeletal muscle index (L3SMI) is a surrogate marker of sarcopenia and frailty in non-small cell lung cancer patients</p>

“…One should take into account the short, overall survival of these patients’ cohort. It may be reasonable to assume that sarcopenia develops at a slower rate when compared to this devastating disease similar to the results of other studies on rapid progressing cancers, such as pancreatic cancer 23,24. Therefore, sarcopenia would become more valuable, as a prognostic tool, in cases of prolonged survival, as in cases of other, less lethal cancer types which are evidently heterogeneous with regard to the impact of sarcopenia and frailty on survival.…”

The Prognostic Value of Low Muscle Mass in Pancreatic Cancer Patients: A Systematic Review and Meta-Analysis

“…Six articles defined muscle mass as the area occupied by all the muscles at the level of L3 normalized for height (L3-SMI) [ 35 , 36 , 37 , 38 , 39 , 40 ]. Four articles defined muscle mass as the total psoas area normalized for height [ 31 , 32 ] or normalized for the cross-sectional area of the body at the level of L3 [ 34 ] or L5 [ 33 ]. Amini et al also evaluated the total psoas volume normalized for height at the level of L3 (see Table 1 for details) [ 32 ].…”

“…Three articles defined low muscle mass as sarcopenia using predefined cut-offs already published in the literature [ 36 , 39 , 40 ]. Six articles [ 31 , 32 , 34 , 35 , 37 , 38 ] used self-determined cut-offs, whereas Delitto et al [ 34 ] and Clark et al [ 33 ] conducted correlation analyses as depicted in Table 1 .…”

Impact of progressive resistance training on CT quantified muscle and adipose tissue compartments in pancreatic cancer patients

“…Low muscle mass has previously been reported to be predictive of poor overall survival in resectable and advanced pancreatic cancer [ 24 – 26 , 37 , 38 ]. Several other studies couldn’t show a predictive impact of muscle mass at a single time point with pancreatic cancer and lung cancer [ 9 , 39 ]. Nevertheless, a high absolute amount of muscle mass still seems advantageous.…”