The role of sarcopenia in patients with intrahepatic cholangiocarcinoma: Prognostic marker or hyped parameter?

Abstract

Background & Aims:Sarcopenia has emerged as a prognostic parameter in numerous cancer entities. Current research favours its role as a determining factor for overall survival (OS) in patients with intrahepatic cholangiocarcinoma (ICC); however, it is unclear whether sarcopenia is a truly independent survival predictor if combined with established prognostic factors. Methods:Between 1997-2018, 417 patients with histopathologically confirmed ICC were referred to our centre, of whom 293 were included in this study. Cross-sectional imaging, laboratory examinations and histopathological reports were retrospectively analysed. Psoas muscle index (PMI) as easy-to-measure marker of sarcopenia was calculated. Using optimal stratification, sex-specific PMI cut-offs were calculated and tested in hazard regression models against previously published risk factors-for the entire cohort, and within resected and non-resected subgroups. Results:Median OS for patients with low respectively high PMI was 23.5 and 34.5 months in the resected subgroup (P = 0.008) and 5.1 and 7.8 months (P = 0.01) in the non-resected subgroup. In multivariate hazard regression models for the entire cohort, low PMI exhibited independent predictive value (P = 0.01) as did translobar tumour spread (P = 0.005), extrahepatic extension (P = 0.03), tumour boundary type (P < 0.001), carbohydrate antigen 19-9 (CA 19-9) levels (P = 0.001), alkaline phosphatase levels (P = 0.001) and distant metastasis (P < 0.001). In subgroup analyses, low PMI remained predictive among non-resected patients (P = 0.03), but lost its predictive value among resected patients (P = 0.15). Conclusions:Psoas muscle index strongly predicted OS in univariate analysis.However, addition of established risk factors eliminated its predictive value among resected patients. Thus, when resection is deemed oncologically reasonable, patients should not be excluded from surgery because of sarcopenia alone.

Risk Stratification in Advanced Biliary Tract Cancer: Validation of the A.L.A.N. Score

“…score and the disease status were independent prognostic factors for median OS. This accords with previously published results: patients with metastatic disease typically have worse prognoses than patients with locally advanced disease [ 14 , 15 , 29 ].…”

Survival Prediction in Intrahepatic Cholangiocarcinoma: A Proof of Concept Study Using Artificial Intelligence for Risk Assessment

“…This score consists of five common parameters assessed during standard work-up at the time of initial diagnosis and is not based on histopathological factors [ 14 ]. In a previous study by our group, all the included factors correlated with an impaired survival in our patient cohort [ 25 ]. Thus, the high discriminative ability ( p < 0.001) of the score in this study is not surprising.…”

“…However, they may not cover the clinical complexity because they are all based only on a few, mainly tumor burden-associated factors. Knowledge about novel risk factors, such as the tumor microenvironment, the influence of inflammation and immune reactions, body composition assessment, tumor standardized uptake in hybrid positron emission tomography/computed tomography imaging, and image-based texture analysis has continuously been increasing [ 25 , 32 , 33 , 34 , 35 , 36 , 37 ]. Therefore, the integration of these factors into scoring systems has great potential.…”

“…According to the current AJCC/UICC TNM staging system, an extrahepatic spread exists if the tumor perforates the viscera of the liver and/or infiltrates adjacent organs [ 24 ]. The psoas muscle index (PMI) was defined as the total area of the psoas muscle at the level of the L3 vertebra divided by the squared body height [ 25 , 26 ]. For the definition of high and low PMI, we used cut-offs derived previously by our group using optimal stratification.…”

“…For the definition of high and low PMI, we used cut-offs derived previously by our group using optimal stratification. In the resected group, “low” was defined as ≤5.7 cm 2 /m 2 for men and ≤5.1 cm 2 /m 2 for women, whereas in the non-resected subgroup, the values were ≤5.5 cm 2 /m 2 for men and ≤4.8 cm 2 /m 2 for women [ 25 ]. In the case of missing data, the information was updated using the radiology information system and the laboratory database.…”