TY - JOUR
T1 - Sarcopenia as a Predictor of Survival in Patients with Pancreatic Adenocarcinoma After Pancreatectomy
AU - Rom, Hadass
AU - Tamir, Shlomit
AU - Van Vugt, Jeroen L.A.
AU - Berger, Yael
AU - Perl, Gali
AU - Morgenstern, Sara
AU - Tovar, Ana
AU - Brenner, Baruch
AU - Benchimol, Daniel
AU - Kashtan, Hanoch
AU - Sadot, Eran
N1 - Publisher Copyright:
© 2021, Society of Surgical Oncology.
PY - 2022/3
Y1 - 2022/3
N2 - Objective: To determine whether sarcopenia can potentially predict worse survival after resection of pancreatic ductal adenocarcinoma. Background: Sarcopenia is correlated with poor outcomes in hepatopancreatobiliary malignancies, but the relationship of both its qualitative and quantitative features with patient survival after pancreatectomy has not been investigated in a western population. Patients and Methods: Preoperative cross-sectional computed tomography scans of consecutive patients who underwent pancreatectomy in 2005–2017 were evaluated for skeletal muscle index (SMI), intramuscular adipose tissue content (IMAC), and visceral-to-subcutaneous adipose tissue area ratio (VSR). Sex-specific categorical cut-offs were determined. Findings were correlated with outcome. Results: The study included 111 patients, 47% of whom were female, with a median age of 67 years (range: 35–87 years), and median body mass index of 23 kg/m2 (range: 16–40 kg/m2); 77% had a Whipple procedure and 66% received adjuvant chemotherapy. Low SMI correlated with poor overall survival (OS) (P = 0.007), disease-specific survival (DSS) (P = 0.006), and recurrence-free survival (RFS) (P = 0.01). High IMAC correlated with poor OS (P = 0.04). Patients with high IMAC tended to have a shorter DSS (P = 0.09), with no correlation with RFS (P = 0.6). VSR was not associated with survival. Multivariable analysis yielded an independent association of low SMI with OS (HR = 1.7, 95%CI: 1.1–2.8, P = 0.02), DSS (HR = 1.8, 95%CI: 1.03–3.2, P = 0.04), and RFS (HR = 1.8, 95%CI: 1.1–2.8, P = 0.01), and of high IMAC with OS (HR = 1.9, 95%CI: 1.1–3.1, P = 0.01). Conclusion: Both qualitative and quantitative measures of skeletal muscle were independently associated with impaired survival in patients with resectable PDAC. Sarcopenia might serve as an early radiographic surrogate of aggressive tumor behavior, with potential implications for clinical decision-making and future study.
AB - Objective: To determine whether sarcopenia can potentially predict worse survival after resection of pancreatic ductal adenocarcinoma. Background: Sarcopenia is correlated with poor outcomes in hepatopancreatobiliary malignancies, but the relationship of both its qualitative and quantitative features with patient survival after pancreatectomy has not been investigated in a western population. Patients and Methods: Preoperative cross-sectional computed tomography scans of consecutive patients who underwent pancreatectomy in 2005–2017 were evaluated for skeletal muscle index (SMI), intramuscular adipose tissue content (IMAC), and visceral-to-subcutaneous adipose tissue area ratio (VSR). Sex-specific categorical cut-offs were determined. Findings were correlated with outcome. Results: The study included 111 patients, 47% of whom were female, with a median age of 67 years (range: 35–87 years), and median body mass index of 23 kg/m2 (range: 16–40 kg/m2); 77% had a Whipple procedure and 66% received adjuvant chemotherapy. Low SMI correlated with poor overall survival (OS) (P = 0.007), disease-specific survival (DSS) (P = 0.006), and recurrence-free survival (RFS) (P = 0.01). High IMAC correlated with poor OS (P = 0.04). Patients with high IMAC tended to have a shorter DSS (P = 0.09), with no correlation with RFS (P = 0.6). VSR was not associated with survival. Multivariable analysis yielded an independent association of low SMI with OS (HR = 1.7, 95%CI: 1.1–2.8, P = 0.02), DSS (HR = 1.8, 95%CI: 1.03–3.2, P = 0.04), and RFS (HR = 1.8, 95%CI: 1.1–2.8, P = 0.01), and of high IMAC with OS (HR = 1.9, 95%CI: 1.1–3.1, P = 0.01). Conclusion: Both qualitative and quantitative measures of skeletal muscle were independently associated with impaired survival in patients with resectable PDAC. Sarcopenia might serve as an early radiographic surrogate of aggressive tumor behavior, with potential implications for clinical decision-making and future study.
KW - Intramuscular adipose tissue
KW - Pancreatectomy
KW - Pancreatic ductal adenocarcinoma
KW - Sarcopenia
KW - Skeletal muscle
KW - Survival
KW - Visceral adipose tissue subcutaneous adipose tissue
UR - http://www.scopus.com/inward/record.url?scp=85118294988&partnerID=8YFLogxK
U2 - 10.1245/s10434-021-10995-y
DO - 10.1245/s10434-021-10995-y
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C2 - 34716836
AN - SCOPUS:85118294988
SN - 1068-9265
VL - 29
SP - 1553
EP - 1563
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 3
ER -