Postoperative muscle mass restoration as a prognostic factor in patients with resected pancreatic cancer

Abstract

Background Recent studies have found that muscle depletion may be a prognostic predictor in patients with pancreatic cancer (PC). However, in these studies, limited data were used to assess the relationship between the serial change in body composition and outcomes after PC resection. Hence, we evaluated the changes in body composition during the perioperative period in patients with PC and their association with the overall survival (OS). Methods A total of 89 patients with PC who received surgery with curative intent between 2006 and 2015 were included in this study retrospectively. These patients underwent serial computed tomography (CT) scans: preoperatively, immediately after surgery (4 weeks), and 12 and 24 weeks after resection. The muscle and visceral fat areas were measured at the third lumbar vertebra level on cross-sectional CT images using sliceOmatic V5.0 program (TomoVision, Canada). The body composition ratio was determined by dividing the post-resection body composition at each point (4, 12, and 24 weeks) by the pre-resection body composition. Patients were divided into two groups-higher and lower groups-based on this body composition ratio (skeletal muscle mass ratio [SMR], visceral fat mass ratio [VFR]). The OS was compared between the two groups using the log-rank test. Results The median age of patients was 63 (27-84) years, and the baseline body mass index was 23.0 (17.0-35.8) kg/m 2. In the comparison of the SMR, there was no significant difference in the OS between the two groups at 4 and 12 weeks (4 weeks, P = 0.488; 12 weeks, P = 0.397). However, the higher group showed a longer OS than the lower group at 24 weeks (39 vs. 20 months, P = 0.008). Similarly, in the VFR, there was no significant difference in the OS between the two groups at 4 and 12 weeks (4 weeks, P = 0.732; 12 weeks, P = 0.060). However, the OS was longer in the higher group at 24 weeks (35 vs. 22 months,

Muscle mass change using linear measurement analysis after nephrectomy for pT3 and pT4 renal cell carcinoma is associated with mortality

“…4 Measuring the total cross-sectional area of the lumbar musculature is a reliable method to determine skeletal muscle composition, and as shown in previous cancer studies, has demonstrated prognostic utility. [5][6][7][8][9][10][11][12][13] However, this gold standard metric requires specialized training, expensive software, and is time consuming, all of which may potentially disturb the clinical workflow. 13 By contrast, measuring the linear area of the lumbar psoas and paraspinal musculature offers a reliable substitute, as it can be quickly performed and only requires a digital ruler tool found in virtually all radiologic software programs.…”

“…14,15 It has been widely established that preoperative skeletal muscle deficiency is associated with adverse outcomes in patients with various malignancies, including RCC, bladder cancer, and urothelial carcinoma. [6][7][8][11][12][13] However, these studies fail to consider the dynamic nature of skeletal muscle change during cancer and its associated treatments, and how continuous degeneration or potential recovery may influence a patient's clinical trajectory. 13,16 Studies that have evaluated postoperative muscle restoration have demonstrated its prognostic capability, but by contrast, have been among patients undergoing extirpative surgery for malignancies other than those of renal origin, such as pancreatic, 7 periampullary, 8 non-small cell lung, 9 gastric, 10 and oesophageal 11 cancer.…”

“…[6][7][8][11][12][13] However, these studies fail to consider the dynamic nature of skeletal muscle change during cancer and its associated treatments, and how continuous degeneration or potential recovery may influence a patient's clinical trajectory. 13,16 Studies that have evaluated postoperative muscle restoration have demonstrated its prognostic capability, but by contrast, have been among patients undergoing extirpative surgery for malignancies other than those of renal origin, such as pancreatic, 7 periampullary, 8 non-small cell lung, 9 gastric, 10 and oesophageal 11 cancer. By contrast, to our knowledge, only one study thus far has investigated the prognostic effects of skeletal muscle recovery in surgical RCC patients.…”

“…Skeletal muscle loss is one such factor, frequently present in patients with malignancy due to a variety of mechanisms, such as the activation of peripheral and central catabolic pathways secondary to increased systemic inflammation 4 . Measuring the total cross‐sectional area of the lumbar musculature is a reliable method to determine skeletal muscle composition, and as shown in previous cancer studies, has demonstrated prognostic utility 5–13 . However, this gold standard metric requires specialized training, expensive software, and is time consuming, all of which may potentially disturb the clinical workflow 13 .…”

“…It has been widely established that preoperative skeletal muscle deficiency is associated with adverse outcomes in patients with various malignancies, including RCC, bladder cancer, and urothelial carcinoma 6–8,11–13 . However, these studies fail to consider the dynamic nature of skeletal muscle change during cancer and its associated treatments, and how continuous degeneration or potential recovery may influence a patient's clinical trajectory 13,16 .…”