Clinical impact of sarcopenia on prognosis in pancreatic ductal adenocarcinoma.

Abstract

259 Background: In the past, various prognostic factors in pancreatic ductal carcinoma (PDAC) have been identified, and there found to be not only tumor-specific clinicopathological factors but also individual patient characteristics. In particular, weight loss, muscle wasting and cachexia are hallmarks of PDAC that may be associated with depletion of both skeletal muscle and adipose tissue. Most notably, sarcopenia is defined to be degenerative loss of skeletal muscle mass that is quantifiable using cross sectional imaging computed tomography (CT) by measurement of psoas area and the muscle’s density. Furthermore, visceral adipose tissue loss also has been reported to associate with a poor survival among patients with PDAC. Methods: A total of 265 patients who underwent curative surgery for PDAC were examined in this study. The total skeletal muscle and fat tissue areas were evaluated in a single image obtained at the third lumber vertebra during a preoperative computed tomography (CT) scan. The patients were assigned to either the sarcopenia or non-sarcopenia group based on their skeletal muscle index (SMI) and classified into high visceral fat area (H-VFA) or low VFA (L-VFA) groups. The association of clinicopathological features and prognosis with the body composition were statistically analyzed. Results: There were 170 patients (64.2%) with sarcopenia. The median survival time (MST) was 23.7 months for sarcopenia patients and 25.8 months for patients without sarcopenia. The MST was 24.4 months for H-VFA patients and 25.8 months for L-VFA patients. However, sarcopenia patients with BMI ≥ 22 exhibited significantly poorer survival than patients without sarcopenia (MST: 19.2 vs. 35.4 months, P = 0.025). There was a significant difference between patients with and without sarcopenia who did not receive chemotherapy (5-year survival rate: 0% vs. 68.3%, P = 0.003). The multivariate analysis revealed that tumor size, positive dissected peripancreatic tissue margin, and sarcopenia were independent prognostic factors. Conclusions: Sarcopenia is an independent prognostic factor in PDAC patients with a BMI ≥ 22. Therefore, evaluating skeletal muscle mass may be a simple and useful approach for predicting patient prognosis.

Body Composition Influences Post-Operative Complications and 90-Day and Overall Survival in Pancreatic Surgery Patients

“…In contrast, other studies failed to demonstrate such an association [9, 22], or were only able to show an association with sarcopenia if BMI was accounted for (which may be thought of as a proxy of body fatness) [8, 12]. Some studies included patients submitted to curative and palliative procedures which obviously have different outcomes [13].…”

“…With regard to nutritional status, recent studies have suggested that body composition phenotypes may influence postoperative and long-term clinical outcomes. Most studies have focused primarily on the impact of sarcopenia (low skeletal-muscle mass) on major postoperative complications [3] and overall survival (OS) [1, 4-12], and secondarily on visceral adipose tissue [3, 8, 10, 13] and low muscle radiation attenuation (a marker of fat infiltration of skeletal muscle) [9-11, 13]. Although some of these studies have included body mass index (BMI) [4, 12] as a proxy of body fatness, the influence of skeletal muscle infiltration by adipose tissue as well as the proportion of visceral adipose tissue with regard to skeletal-muscle tissue has been strikingly less studied.…”