Low Skeletal Muscle Density Is Associated with Early Death in Patients with Perihilar Cholangiocarcinoma Regardless of Subsequent Treatment

Vugt, Jeroen L.A. van; Gaspersz, M.; Vugts, Jaynee; Buettner, Stefan; Levolger, Stef; Bruin, Ron W. F. de; Polak, Wojciech; Jonge, Jeroen de; Willemssen, F.; Koerkamp, Bas Groot; IJzermans, Jan N.M.

doi:10.1159/000486867

Cited by 33 publications

(29 citation statements)

References 42 publications

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“…distal, perihilar, or intrahepatic bile ducts). [18][19][20][21] To date, there are no study analysing the impact of various body compositions on post-operative long-term prognosis by integrating whole biliary tract cancers.…”

Section: Introductionmentioning

confidence: 99%

Impact of preoperative body compositions on survival following resection of biliary tract cancer

Yoon

Choi

Song

et al. 2019

J cachexia sarcopenia muscle

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Background Although surgical resection is the only potentially curative treatment for biliary tract cancer, the prognosis remains poor after a major operation such as pancreatoduodenectomy or hepatectomy. We aimed to investigate the impact of preoperative body compositions on long‐term survival of patients undergoing resection of biliary tract cancer. Methods We analysed data of patients diagnosed with biliary tract cancer who underwent surgery from 2009 to 2015. Skeletal muscle area, skeletal muscle radiation attenuation, and visceral and subcutaneous adipose tissue areas were measured from the computed tomography images at L3 vertebral levels obtained before resection of cancer. Patients were divided into two groups based on the sex‐specific median values for each parameter, and long‐term survival was compared between the groups. Results A total of 371 patients (women, 39.6%; mean age, 66.2 ± 9.6 years) were finally included in the analysis. Patients with low skeletal muscle index (SMI) had significantly shorter median survival than those with high SMI (29 vs. 39 months; P = 0.026). Patients with low skeletal muscle attenuation (SMA) also showed reduced survival compared with those with high SMA (median survival 25 vs. 60 months; P = 0.002). Combining these two factors, survival was highest in the high SMI/high SMA group (reference) and lowest in the low SMI/low SMA group (hazard ratio, 2.18; 95% confidence interval, 1.44–3.30). Visceral and subcutaneous adipose tissue areas were not associated with long‐term survival. Conclusions Low SMI and low SMA on computed tomography scan have a negative impact on survival after resection of biliary tract cancer. They can be used in preoperative risk assessment to assist in treatment decision making.

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Section: Introductionmentioning

confidence: 99%

Impact of preoperative body compositions on survival following resection of biliary tract cancer

Yoon

Choi

Song

et al. 2019

J cachexia sarcopenia muscle

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“…In recent years, an increasing number of studies have focussed on body composition as a new and promising parameter for predicting prognosis in patients with malignancies [11][12][13]. Body composition refers to the distribution of visceral and subcutaneous fat, obtained from information on axial CT-slices at the level of the third lumbar vertebra (L3) and also includes muscle area and muscle density [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Impact of body fat distribution and sarcopenia on the overall survival in patients with spinal metastases receiving radiotherapy treatment: a prospective cohort study

et al. 2019

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Introduction: An increasing number of patients is diagnosed with spinal metastases due to elevated cancer incidence and improved overall survival. Patients with symptomatic spinal bone metastases often receive radiotherapy with or without surgical stabilisation. Patients with a life expectancy of less than 3 months are generally deemed unfit for surgery, therefore adequate pre-treatment assessment of life expectancy is necessary. The aim of this study was to assess new factors associated with overall survival for this category of patients. Patients and methods: Patients who received radiotherapy for thoracic or lumbar spinal metastases from June 2013 to December 2016 were included in this study. The pre-treatment planning CT for radiotherapy treatment was used to assess the patient's visceral fat area, subcutaneous fat area, total muscle area and skeletal muscle density on a single transverse slice at the L3 level. The total muscle area was used to assess sarcopenia. Furthermore, data were collected on age, sex, primary tumour, Karnofsky performance score, medical history, number of bone metastases, non-bone metastases and neurological symptoms. Univariable and multivariable cox regressions were performed to determine the association between our variables of interest and the survival at 90 and 365 days. Results: A total of 310 patients was included. The median age was 67 years. Overall survival rates for 90 and 365 days were 71% and 36% respectively. For 90-and 365-day survival, the Karnofsky performance score, muscle density and primary tumour were independently significantly associated. The visceral or subcutaneous fat area and their ratio and sarcopenia were not independently associated with overall survival. Conclusions: Of the body morphology, only muscle density was statistically significant associated with overall survival after 90 and 365 days in patients with spinal bone metastases. Body fat distribution was not significantly associated with overall survival.

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“… 3 , 11 Finally, resection of pCCA is high-risk surgical procedure with a postoperative 90-day mortality rate between 5 and 18% in Western series, 12 – 15 and as such the possible benefit does not outweigh the risks in patients with advanced age, serious co-morbidity, or frailty. 16 – 18 …”

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confidence: 99%

Eligibility for Liver Transplantation in Patients with Perihilar Cholangiocarcinoma

et al. 2020

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Background Liver transplantation (LT) has been performed in a select group of patients presenting with unresectable or primary sclerosing cholangitis (PSC)-associated perihilar cholangiocarcinoma (pCCA) in the Mayo Clinic with a reported 5-year overall survival (OS) of 53% on intention-to-treat analysis. The objective of this study was to estimate eligibility for LT in a cohort of pCCA patients in two tertiary referral centers. Methods Patients diagnosed with pCCA between 2002 and 2014 were included from two tertiary referral centers in the Netherlands. The selection criteria used by the Mayo Clinic were retrospectively applied to determine the proportion of patients that would have been eligible for LT. Results A total of 732 consecutive patients with pCCA were identified, of whom 24 (4%) had PSC-associated pCCA. Overall, 154 patients had resectable disease on imaging and 335 patients were ineligible for LT because of lymph node or distant metastases. An age limit of 70 years led to the exclusion of 50 patients who would otherwise be eligible for LT. After applying the Mayo Clinic criteria, only 34 patients (5%) were potentially eligible for LT. Median survival from diagnosis for these 34 patients was 13 months (95% CI 3–23). Conclusion Only 5% of all patients presenting with pCCA were potentially eligible for LT under the Mayo criteria. Without transplantation, a median OS of about 1 year was observed.

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Low Skeletal Muscle Density Is Associated with Early Death in Patients with Perihilar Cholangiocarcinoma Regardless of Subsequent Treatment

Cited by 33 publications

References 42 publications

Impact of preoperative body compositions on survival following resection of biliary tract cancer

Impact of preoperative body compositions on survival following resection of biliary tract cancer

Impact of body fat distribution and sarcopenia on the overall survival in patients with spinal metastases receiving radiotherapy treatment: a prospective cohort study

Eligibility for Liver Transplantation in Patients with Perihilar Cholangiocarcinoma

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