Sarcopenia and survival in patients undergoing pancreatic resection

Onesti, Jill K.; Wright, G. Paul; Kenning, Sarah E.; Tierney, Mark T.; Davis, Alan T.; Doherty, Michael G.; Chung, Mathew H.

doi:10.1016/j.pan.2016.01.009

Cited by 50 publications

(39 citation statements)

References 32 publications

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“…For stage 2-3 gastric cancer, patients with sarcopenia showed a higher rate of postoperative complications and a poorer overall and recurrence-free survival than those without sarcopenia (8,11). Pancreatic cancer patients with sarcopenia who underwent pancreatectomy also showed a poorer overall survival than the patients without sarcopenia (12).…”

Section: Discussionmentioning

confidence: 97%

A low psoas muscle volume predicts longer hospitalization and cancer recurrence in upper urinary tract urothelial carcinoma

et al. 2017

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Section: Discussionmentioning

confidence: 97%

A low psoas muscle volume predicts longer hospitalization and cancer recurrence in upper urinary tract urothelial carcinoma

et al. 2017

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“…The next best option is to use data from multiple studies using percentile based summative values. The literature currently uses a plethora of cohort-specific values, including using the lowest median, tertile, quartile, quintile, or standard deviation (19)(20)(21)23,24,27,28,(33)(34)(35)(36)(37)(38) in the study cohort. We validated our cohort's cutoff, by performing ROC curve analysis with regards to acute radiotoxicities which correlates to approximately a TPA of 500.…”

Section: Discussionmentioning

confidence: 99%

“…Another metric, body surface area (BSA), has been incorporated clinically to personalize chemotherapeutic doses based on patient size and visceral fat content (15)(16)(17). A relatively new metric, total psoas area (TPA), has shown promise as an additional proxy for nutritional status; specifically, low TPA, or sarcopenia, has been used in place of deficient nutritional status in gastrointestinal cancers (18,19).…”

Section: Introductionmentioning

confidence: 99%

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Impact of sarcopenia in borderline resectable and locally advanced pancreatic cancer patients receiving stereotactic body radiation therapy

Jin¹,

Mellon²,

Frakes³

et al. 2018

J. Gastrointest. Oncol.

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Background: Total psoas area (TPA), a marker of sarcopenia, has been used as an independent predictor of clinical outcomes in gastrointestinal (GI) cancers as a proxy for frailty and nutritional status. Our study aimed to evaluate whether TPA, in contrast to traditional measurements of nutrition like body mass index (BMI) and body surface area (BSA), was predictive of outcomes in borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) patients receiving stereotactic body radiation therapy (SBRT). Methods: Retrospective analysis of an institutional review board approved database of 222 BRPC and LAPC treated with SBRT from 2009-2016 yielded 183 patients that met our selection criteria of pre-SBRT computed tomography (CT) imaging with an identifiable L4 vertebra. Once the L4 vertebral level was identified, the bilateral psoas muscles were manually contoured. This area was normalized by patient height, with units described in mm 2 /m 2 . Receiver operating characteristic (ROC) curves were generated for TPA, BMI, and BSA to elicit clinically relevant cutoffs. Regression and Kaplan-Meier analyses were used to correlate toxicity with survival functions.Results: Low TPA (OR =1.903, P=0.036) was predictive of acute toxicities, and only TPA was predictive of Grade 3 or higher acute toxicities (OR =10.24, P=0.007). Both findings were independent of tumor resectability. Pain (P=0.003), fatigue (P=0.040), and nausea (P=0.039) were significantly associated with low TPA. No association was identified between any measurement of nutritional status and the development of late toxicities, overall survival, local progression or local recurrence. However, BRPC patients survived longer (median =21.98 months) than their LAPC (median =16.2 months) counterparts (P=0.002), independent of nutritional status. Conclusions: TPA measurement is readily available and more specific than BMI or BSA as a predictor of acute radiotoxic complications following SBRT in BRPC/LAPC patients. A TPA of <500 mm 2 /m 2 is a clinically relevant cutoff that can direct physicians to address expected complications of pain, fatigue, and nausea. However, tumor resectability remains as the only predictor of overall survival in this cohort.

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“…A number of studies have demonstrated that DSMM could be an adverse predictor for patients with PC who were treated with surgical resection (16,(19)(20)(21)(22)(23). However, to the best of our knowledge, there are few reports regarding the impact of DSMM on survival in patients with unresectable APC undergoing systemic chemotherapy (24,25).…”

Section: Effect Of Pretreatment Psoas Muscle Mass On Survival For Patmentioning

confidence: 99%

Effect of pretreatment psoas muscle mass on survival for patients with unresectable pancreatic cancer undergoing systemic chemotherapy

et al. 2017

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Abstract. To the best of our knowledge, there are few previous studies that have investigated the effect of decreased skeletal muscle mass (DSMM) on survival in patients with unresectable advanced pancreatic cancer (APC) who are undergoing systemic chemotherapy. Thus, the present study aimed to investigate the impact of DSMM, as determined by the psoas muscle index (PMI) following computed tomography and prior to systemic chemotherapy, on the outcomes of patients with unresectable APC (n=61). The primary endpoint used was the overall survival (OS) rate. The OS rates in the PMI-High group (exceeds the median PMI value in each gender) were retrospectively compared with those in the PMI-Low group (below the median PMI value in each gender), and factors associated with OS were investigated using univariate and multivariate analyses. The study cohort included 31 male and 30 female patients with a median age of 72 years, 13 of whom were stage IVA, and 48 were stage IVB. ). The proportion of patients with performance status 0 in the PMI-High group was significantly high, compared with that in the PMI-Low group [83.3% (25/30) vs. 58.1% (18/31); P=0.0486]. Body mass index in the PMI-High group was significantly higher compared with that in the PMI-Low group (P=0.0154). The 1-year cumulative survival rate was 43.3% in the PMI-High group and 12.9% in the PMI-Low group (P=0.0027). Following multivariate analysis, PMI (P=0.0036), prothrombin time (P=0.0044) and carbohydrate antigen 19-9 (P= 0.0451) were identified to be significant predictors of OS. In conclusion, DSMM, as determined by the PMI, could be a significant predictor of prognosis in patients with unresectable APC who are receiving systemic chemotherapy.

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Sarcopenia and survival in patients undergoing pancreatic resection

Cited by 50 publications

References 32 publications

A low psoas muscle volume predicts longer hospitalization and cancer recurrence in upper urinary tract urothelial carcinoma

A low psoas muscle volume predicts longer hospitalization and cancer recurrence in upper urinary tract urothelial carcinoma

Impact of sarcopenia in borderline resectable and locally advanced pancreatic cancer patients receiving stereotactic body radiation therapy

Effect of pretreatment psoas muscle mass on survival for patients with unresectable pancreatic cancer undergoing systemic chemotherapy

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