Clinical impact of sarcopenia on prognosis in pancreatic ductal adenocarcinoma: A retrospective cohort study

Ninomiya, Go; Fujii, Tsutomu; Yamada, Suguru; Yabusaki, Norimitsu; Suzuki, Kôjiro; Iwata, Nakao; Kanda, Mitsuro; Hayashi, Masamichi; Tanaka, Chie; Nakayama, Goro; Sugimoto, Hiroyuki; Koike, Masahiko; Fujiwara, Michitaka; Kodera, Yasuhiro

doi:10.1016/j.ijsu.2017.01.075

Cited by 79 publications

(81 citation statements)

References 42 publications

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“…Approximately 73% of patients were sarcopenic at baseline according to previous data, and most of them had normal BMI (median BMI: 24.1 kg/m 2 ). Furthermore, 33% of sarcopenic patients and 35% of patients with early LSMM had a BMI > 25 kg/m 2 .…”

Section: Discussionmentioning

confidence: 92%

“…PC patients have shorter survival and an increased risk of distant metastases . Furthermore, the prognosis of these patients is conditioned by a higher incidence of malnutrition or cachexia, present in 70–80% of PC patients, responsible for at least 20% of all deaths . In fact, multiple risk factors for loss of skeletal muscle mass (LSMM) due to cancer‐related factors and medical treatment concur to cause more treatment toxicities, asthenia, fatigue, reduced response to cancer therapy, prolonged hospitalization, impaired quality of life, and, therefore, a worse prognosis .…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Furthermore, the prognosis of these patients is conditioned by a higher incidence of malnutrition or cachexia, present in 70-80% of PC patients, responsible for at least 20% of all deaths. [4][5][6][7] In fact, multiple risk factors for loss of skeletal muscle mass (LSMM) due to cancer-related factors and medical treatment concur to cause more treatment toxicities, asthenia, fatigue, reduced response to cancer therapy, prolonged hospitalization, impaired quality of life, and, therefore, a worse prognosis. 2,6,8,9 However, the identification of patients with muscle loss has become increasingly difficult, because~40-60% of cancer patients are overweight or obese, even in the metastatic setting.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7] In fact, multiple risk factors for loss of skeletal muscle mass (LSMM) due to cancer-related factors and medical treatment concur to cause more treatment toxicities, asthenia, fatigue, reduced response to cancer therapy, prolonged hospitalization, impaired quality of life, and, therefore, a worse prognosis. 2,6,8,9 However, the identification of patients with muscle loss has become increasingly difficult, because~40-60% of cancer patients are overweight or obese, even in the metastatic setting. 3 Sarcopenia was defined by Evans as LSMM, which results in decreased strength and aerobic capacity and, thus, functional capacity.…”

Section: Introductionmentioning

confidence: 99%

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The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients

Basile

Parnofiello

Vitale

et al. 2019

J cachexia sarcopenia muscle

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Background Pancreatic cancer (PC) patients have multiple risk factors for sarcopenia and loss of skeletal muscle mass (LSMM), which may cause greater treatment toxicities, reduced response to cancer therapy, prolonged hospitalization, impaired quality of life, and worse prognosis. Methods This is a retrospective study on advanced PC patients treated at the Department of Oncology of Udine, Italy, from January 2012 to November 2017. Among 162 patients who received chemotherapy, 94 consecutive patients with an available computed tomography (CT) scan were retrospectively analyzed. The primary objective of our study was to explore if an early LSMM ≥ 10% (measured at first radiological evaluation and compared with baseline) and/or baseline sarcopenia may impact prognosis. Baseline sarcopenia was defined according to Prado's criteria. Skeletal muscle area was measured as cross‐sectional areas (cm 2 ) using CT scan data through the Picture archiving and communication system (PACS) image system. Results In the whole cohort, 48% of patients were ≤70 years old, and 50% had metastatic disease. At baseline, 73% of patients had sarcopenia, and 16% presented a visceral fat area ≥ 44 cm 2 /m 2 . Overall, 21% experienced an early LSMM ≥ 10%. Approximately 33% of sarcopenic patients at baseline and ~35% of patients with early LSMM ≥ 10% had a body mass index > 25 kg/m 2 . Of note, 71% of patients were evaluated by a nutritionist, and 56% received a dietary supplementation (oral and/or parenteral). After a median follow‐up of 30.44 months, median overall survival (OS) was 11.28 months, whereas median progression‐free survival (PFS) was 5.72 months. By multivariate analysis, early LSMM ≥ 10% was significantly associated with worse OS [hazard ratio (HR): 2.16; 95% confidence interval (CI) 1.23–3.78; P = 0.007] and PFS (HR: 2.31; 95% CI 1.30–4.09; P = 0.004). Moreover, an exploratory analysis showed that inflammatory indexes, such as neutrophil–lymphocyte ratio variation, impact early LSMM ≥ 10% (odds ratio 1.31, 95% CI 1.06–1.61, P = 0.010). Conclusions Early LSMM ≥ 10% has a negative prognostic role in advanced PC patients. Further prospective investigations are needed to confirm these preliminary data.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients

Basile

Parnofiello

Vitale

et al. 2019

J cachexia sarcopenia muscle

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“…3,4 Recently, this condition has been found to be associated with increased adverse perioperative outcomes in the general, thoracic, and transplant surgery literature. [5][6][7][8][9][10][11][12] New methods of identifying sarcopenia through analysis of cross-sectional computed tomography (CT) scans by commercially and publicly available software has been developed. 13 The incidence and significance of sarcopenia has not been evaluated in patients undergoing breast reconstruction with autologous free tissue transfer.…”

mentioning

confidence: 99%

Preoperatively Identified Sarcopenia Leads to Increased Postoperative Complications, Hospital and ICU Length of Stay in Autologous Microsurgical Breast Reconstruction

Pittelkow

DeBrock

McLaughlin

et al. 2019

J reconstr Microsurg

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Background Sarcopenia is a condition characterized by the loss of skeletal muscle mass and strength. Recently, there has been a tremendous amount of research into the prognostic value of sarcopenia in surgical outcomes. The purpose of this study was to compare postoperative outcomes in free flap breast reconstruction in patients with and without sarcopenia. Methods One hundred three patients who underwent autologous breast reconstruction from 2013 to 2016 were studied. The cross-sectional area (CSA) of skeletal muscle was measured from preoperative computed tomography images at L3 using the National Institutes of Health ImageJ software. CSA was then normalized to patient stature by dividing CSA by height (cm2/m2). A previously published skeletal muscle index cutoff of 38.5 cm2/m2 was used to define sarcopenia. Intraoperative and postoperative surgical outcomes were recorded retrospectively. Outcomes were analyzed using multivariate, univariate, and regression statistics. Results Eight of the 103 (7.8%) patients were found to have sarcopenia. Sarcopenia was associated with a statistically significant increase in flap site delayed healing (37.5% vs. 20%, p = 0.046), take back to the operating room (25% vs. 11.6%, p = 0.05), intensive care unit length of stay (1.5 vs. 0.02 days, p < 0.0005), and hospital length of stay (8.38 vs. 5.49 days, p < 0.0005) when compared with patients without sarcopenia. There were no significant differences in flap loss, surgical site infection, hematoma, seroma, donor site delayed healing, intraoperative complications, and number of revision surgeries. Conclusion Sarcopenia is significantly associated with increased complications in patients undergoing free flap breast reconstruction. Further investigation into the biochemical and physiologic changes associated with sarcopenia is needed.

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Association of Sarcopenia With Oncologic Outcomes of Primary Surgery or Definitive Radiotherapy Among Patients With Localized Oropharyngeal Squamous Cell Carcinoma

Olson

Edwards

Stone

et al. 2020

JAMA Otolaryngol Head Neck Surg

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The negative association of low lean muscle mass (sarcopenia) with survival outcomes in head and neck cancers, including oropharyngeal carcinoma, is established. However, it is not known whether the choice of primary treatment modality (surgery or radiotherapy) is associated with oncologic outcomes of patients with sarcopenia and oropharyngeal squamous cell carcinoma (OPSCC).OBJECTIVE To examine whether primary surgical resection or definitive radiotherapy is associated with improved survival for patients with sarcopenia and localized OPSCC. DESIGN, SETTING, AND PARTICIPANTSA cohort study was conducted of patients with clinically staged T1 to T2, N0 to N2 OPSCC with cross-sectional abdominal imaging within 60 days prior to treatment and treated between January 1, 2005, and December 31, 2017. Skeletal muscle mass was measured at the third lumbar vertebra using previously defined techniques and sarcopenia was defined as less than 52.4 cm 2 /m 2 of muscle for men and less than 38.5 cm 2 /m 2 for women. In addition, associated patient demographic characteristics, cancer data, treatment information, and survival outcomes were assessed. Statistical analysis was performed from December 3, 2018, to August 28, 2019.MAIN OUTCOMES AND MEASURES Primary outcomes were overall survival and disease-specific survival. RESULTS Among the 245 patients who met study inclusion criteria, 209 were men (85.3%) and the mean (SD) age was 62.3 (7.8) years. Sarcopenia was detected in 135 patients (55.1%), while normal skeletal muscle mass was detected in 110 patients (44.9%). For the 110 patients without sarcopenia, primary treatment modality was not associated with improved survival. For patients with sarcopenia at diagnosis, primary surgical resection was associated with improved overall survival (hazard ratio [HR], 0.37; 95% CI, 0.17-0.82) and disease-specific survival (HR, 0.22; 95% CI, 0.07-0.68). This association persisted after propensity score matching, as up-front surgery was associated with improved overall survival (HR, 0.33; 95% CI, 0.12-0.91) and disease-specific survival (HR, 0.17; 95% CI, 0.04-0.75) survival. CONCLUSIONS AND RELEVANCEThis study suggests that sarcopenia has a negative association with survival for patients with OPSCC. Primary surgery and radiotherapy confer similar survival associations for patients with normal skeletal muscle mass and localized OPSCC. However, up-front surgical resection may be associated with improved survival outcomes for patients with sarcopenia.

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Clinical impact of sarcopenia on prognosis in pancreatic ductal adenocarcinoma: A retrospective cohort study

Abstract: 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.

Cited by 79 publications

References 42 publications

The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients

The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients

Preoperatively Identified Sarcopenia Leads to Increased Postoperative Complications, Hospital and ICU Length of Stay in Autologous Microsurgical Breast Reconstruction

Association of Sarcopenia With Oncologic Outcomes of Primary Surgery or Definitive Radiotherapy Among Patients With Localized Oropharyngeal Squamous Cell Carcinoma

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