Preoperative computed tomography measurements of pancreatic steatosis and visceral fat: prognostic markers for dissemination and lethality of pancreatic adenocarcinoma

Abstract

In resected pancreatic adenocarcinoma, increased pancreatic steatosis and increased visceral fat stores are associated with lymphatic metastases. Furthermore, increased visceral fat is associated with abbreviated survival in patients with lymphatic metastases. Hence, increased visceral fat may be a causative factor of abbreviated survival and serves a prognostic role in patients with pancreatic malignancies.

Increasing body mass index portends abbreviated survival following pancreatoduodenectomy for pancreatic adenocarcinoma

“…In stark contrast, no difference was noted in the subcutaneous fat pad. 16 Balentine et al 31 confirmed are findings showing that visceral fat and not BMI was associated with a worse overall survival.…”

“…Epidemiologic evidence suggests that the relative risk of pancreatic cancer increases by 1.12 for every 5-point increase in BMI. 16 Furthermore, patients with a BMI greater than 35 have a 45% greater risk of development of pancreatic cancer. 13 Additionally, Mathur et al have demonstrated that obesity is associated with a worse prognosis from hepato-pancreatico-biliary cancers.…”

“…However, previous data from our group have suggested that BMI does not correlate well with intra-abdominal fat. 16 Given that it is this visceral fat that would likely be the culprit in operative difficulty, these findings should be taken with caution. Additionally, our group is a tertiary referral center for pancreatic adenocarcinoma and has high surgeon volumes for pancreatoduodenectomy; therefore, it is possible that greater surgeon experience and skill could nullify the effects of fat and its related operative difficulty.…”

“…Our group has previously demonstrated that visceral fat infiltration as measured by high-resolution computed tomography predicts increased nodal metastases and decreased survival. 16 To further elucidate the impact of the type of obesity, we measured both visceral fat and subcutaneous fat. Visceral fat pad was increased by 38% in patients with nodal metastases.…”

Adipocytes and Neutrophils Give a Helping Hand to Pancreatic Cancers

“…Moreover, pancreatic steatosis is associated with heightened PDAC risk and plays a negative prognostic role in patients with PDAC ( 1,2 ). Starting from previously published data showing that obesity increases the proinfl ammatory cytokine IL1β and fuels an infl ammatory milieu associated with accelerated tumor growth and metastasis formation, Incio and colleagues show that obesity shapes a distinctive PDAC microenvironment characterized by adipocyte accumulation and hypertrophy, local cross-talk between tumor-associated neutrophils (TAN) and PSCs, and the production of proinfl ammatory and profi brotic factors, which in turn favor tumor progression and severely limit the delivery of chemotherapeutic drugs ( 3 ).…”