Preoperative sarcopenia is associated with poor overall survival in pancreatic cancer patients following pancreaticoduodenectomy
Objectives To analyze the effect of preoperative body composition on survival in patients with pancreatic cancer following pancreaticoduodenectomy (PD). Methods Between October 2005 and August 2018, 116 patients (68 men, 48 women, mean age 66.2 ± 11.9 years) diagnosed with pancreatic adenocarcinoma...
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| Veröffentlicht in: | European radiology 2021-04, Vol.31 (4), p.2472-2481 |
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| creator | Peng, Yan-Chih Wu, Chien-Hui Tien, Yu-Wen Lu, Tzu-Pin Wang, Yu-Hsin Chen, Bang-Bin |
| description | Objectives
To analyze the effect of preoperative body composition on survival in patients with pancreatic cancer following pancreaticoduodenectomy (PD).
Methods
Between October 2005 and August 2018, 116 patients (68 men, 48 women, mean age 66.2 ± 11.9 years) diagnosed with pancreatic adenocarcinoma following PD were retrospectively enrolled. The preoperative CT on vertebral level L3 was assessed for total abdominal muscle area (TAMA), visceral adipose tissue area (VAT), subcutaneous adipose tissue area (SAT), and mean skeletal muscle attenuation (SMD). The clinical data and pathological findings of tumors were collected. The impact of these factors on disease-free survival (DFS) and overall survival (OS) was evaluated by the Kaplan–Meier method and by univariable and multivariable Cox proportional hazards models.
Results
The 3-year DFS and OS rates were 8% and 25%, respectively. Of 116 patients, 20 (17.2%), 3 (2.6%), and 46 (39.7%) patients were classified as having sarcopenia, sarcopenic obesity, and myosteatosis, respectively. The VAT–TAMA ratio (1.2 ± 0.7 vs 0.9 ± 0.5,
p
= 0.01) and the visceral to subcutaneous adipose tissue area ratio (1.3 ± 0.7 vs 0.9 ± 0.5,
p
= 0.04) were higher in sarcopenic patients than in the nonsarcopenic group. Preoperative sarcopenia and sarcopenic obesity were associated with shorter OS (
p
= 0.012 and
p
= 0.041, respectively), but not shorter DFS. Myosteatosis was neither associated with DFS nor OS. On multivariable analysis, sarcopenia was the only significant prognostic factor for OS (
p
= 0.039).
Conclusions
Preoperative sarcopenia assessed by CT is a poor prognostic factor for OS in pancreatic cancer patients after PD.
Key Points
•
Sarcopenia and sarcopenic obesity can be evaluated by abdominal CT on L3 level.
•
Patients with diabetes mellitus (DM) had lower sex-standardized subcutaneous adipose tissue area index and skeletal muscle density and higher visceral to subcutaneous adipose tissue area ratio than did those without DM.
•
Preoperative sarcopenia, sarcopenic obesity, and new-onset diabetes mellitus may predict poor overall survival in pancreatic cancer patients following pancreaticoduodenectomy. |
| doi_str_mv | 10.1007/s00330-020-07294-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2446664226</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2503051732</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-288a43f5b52e3717d708f9b128206f945fdf5f8ce744ae88928344d55d2069a93</originalsourceid><addsrcrecordid>eNp9kU1vFSEUhonR2NvWP-DCkLhxM3r4GmBpmmpNmtiFXRMuc6g0c4cRZm7TnT9d9NaPuOiCwOE854XkIeQlg7cMQL-rAEJAB7wtza3s9BOyYVLwjoGRT8kGrDCdtlYekeNabwHAMqmfkyPBrZa9hQ35flUwz1j8kvZIqy-hVVPyNFXqa80h-QUHepeWr3TOudC8b_A40rqWfdr7kaaJzn4KBVtEoKEdsbSbJeG0VBrzOOa7NN38A-VhzQNOGJa8uz8lz6IfK7542E_I9YfzL2cX3eXnj5_O3l92QWi1dNwYL0VUW8VRaKYHDSbaLeOGQx-tVHGIKpqAWkqPxlhuhJSDUkPrW2_FCXlzyJ1L_rZiXdwu1YDj6CfMa3Vcyr7vJed9Q1__h97mtUztd44rEKCYFrxR_ECFkmstGN1c0s6Xe8fA_fTjDn5c8-N--XG6Db16iF63Oxz-jPwW0gBxAGprTTdY_r79SOwPGgidYA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2503051732</pqid></control><display><type>article</type><title>Preoperative sarcopenia is associated with poor overall survival in pancreatic cancer patients following pancreaticoduodenectomy</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Peng, Yan-Chih ; Wu, Chien-Hui ; Tien, Yu-Wen ; Lu, Tzu-Pin ; Wang, Yu-Hsin ; Chen, Bang-Bin</creator><creatorcontrib>Peng, Yan-Chih ; Wu, Chien-Hui ; Tien, Yu-Wen ; Lu, Tzu-Pin ; Wang, Yu-Hsin ; Chen, Bang-Bin</creatorcontrib><description>Objectives
To analyze the effect of preoperative body composition on survival in patients with pancreatic cancer following pancreaticoduodenectomy (PD).
Methods
Between October 2005 and August 2018, 116 patients (68 men, 48 women, mean age 66.2 ± 11.9 years) diagnosed with pancreatic adenocarcinoma following PD were retrospectively enrolled. The preoperative CT on vertebral level L3 was assessed for total abdominal muscle area (TAMA), visceral adipose tissue area (VAT), subcutaneous adipose tissue area (SAT), and mean skeletal muscle attenuation (SMD). The clinical data and pathological findings of tumors were collected. The impact of these factors on disease-free survival (DFS) and overall survival (OS) was evaluated by the Kaplan–Meier method and by univariable and multivariable Cox proportional hazards models.
Results
The 3-year DFS and OS rates were 8% and 25%, respectively. Of 116 patients, 20 (17.2%), 3 (2.6%), and 46 (39.7%) patients were classified as having sarcopenia, sarcopenic obesity, and myosteatosis, respectively. The VAT–TAMA ratio (1.2 ± 0.7 vs 0.9 ± 0.5,
p
= 0.01) and the visceral to subcutaneous adipose tissue area ratio (1.3 ± 0.7 vs 0.9 ± 0.5,
p
= 0.04) were higher in sarcopenic patients than in the nonsarcopenic group. Preoperative sarcopenia and sarcopenic obesity were associated with shorter OS (
p
= 0.012 and
p
= 0.041, respectively), but not shorter DFS. Myosteatosis was neither associated with DFS nor OS. On multivariable analysis, sarcopenia was the only significant prognostic factor for OS (
p
= 0.039).
Conclusions
Preoperative sarcopenia assessed by CT is a poor prognostic factor for OS in pancreatic cancer patients after PD.
Key Points
•
Sarcopenia and sarcopenic obesity can be evaluated by abdominal CT on L3 level.
•
Patients with diabetes mellitus (DM) had lower sex-standardized subcutaneous adipose tissue area index and skeletal muscle density and higher visceral to subcutaneous adipose tissue area ratio than did those without DM.
•
Preoperative sarcopenia, sarcopenic obesity, and new-onset diabetes mellitus may predict poor overall survival in pancreatic cancer patients following pancreaticoduodenectomy.</description><identifier>ISSN: 0938-7994</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-020-07294-7</identifier><identifier>PMID: 32974690</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adenocarcinoma ; Adenocarcinoma - complications ; Adenocarcinoma - pathology ; Adenocarcinoma - surgery ; Adipose tissue ; Aged ; Attenuation ; Body Composition ; Cancer ; Composition effects ; Diabetes ; Diabetes mellitus ; Diagnostic Radiology ; Evaluation ; Female ; Hepatobiliary-Pancreas ; Humans ; Imaging ; Internal Medicine ; Interventional Radiology ; Male ; Medical prognosis ; Medicine ; Medicine & Public Health ; Men ; Middle Aged ; Muscle, Skeletal - pathology ; Muscles ; Musculoskeletal system ; Neuroradiology ; Obesity ; Pancreatic cancer ; Pancreatic Neoplasms - complications ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Pancreaticoduodenectomy ; Prognosis ; Radiology ; Retrospective Studies ; Sarcopenia ; Sarcopenia - complications ; Sarcopenia - diagnostic imaging ; Sarcopenia - pathology ; Skeletal muscle ; Statistical models ; Survival ; Tomography, X-Ray Computed ; Tumors ; Ultrasound ; Vertebrae</subject><ispartof>European radiology, 2021-04, Vol.31 (4), p.2472-2481</ispartof><rights>European Society of Radiology 2020</rights><rights>European Society of Radiology 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-288a43f5b52e3717d708f9b128206f945fdf5f8ce744ae88928344d55d2069a93</citedby><cites>FETCH-LOGICAL-c375t-288a43f5b52e3717d708f9b128206f945fdf5f8ce744ae88928344d55d2069a93</cites><orcidid>0000-0001-7058-1427</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-020-07294-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-020-07294-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32974690$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Peng, Yan-Chih</creatorcontrib><creatorcontrib>Wu, Chien-Hui</creatorcontrib><creatorcontrib>Tien, Yu-Wen</creatorcontrib><creatorcontrib>Lu, Tzu-Pin</creatorcontrib><creatorcontrib>Wang, Yu-Hsin</creatorcontrib><creatorcontrib>Chen, Bang-Bin</creatorcontrib><title>Preoperative sarcopenia is associated with poor overall survival in pancreatic cancer patients following pancreaticoduodenectomy</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>Objectives
To analyze the effect of preoperative body composition on survival in patients with pancreatic cancer following pancreaticoduodenectomy (PD).
Methods
Between October 2005 and August 2018, 116 patients (68 men, 48 women, mean age 66.2 ± 11.9 years) diagnosed with pancreatic adenocarcinoma following PD were retrospectively enrolled. The preoperative CT on vertebral level L3 was assessed for total abdominal muscle area (TAMA), visceral adipose tissue area (VAT), subcutaneous adipose tissue area (SAT), and mean skeletal muscle attenuation (SMD). The clinical data and pathological findings of tumors were collected. The impact of these factors on disease-free survival (DFS) and overall survival (OS) was evaluated by the Kaplan–Meier method and by univariable and multivariable Cox proportional hazards models.
Results
The 3-year DFS and OS rates were 8% and 25%, respectively. Of 116 patients, 20 (17.2%), 3 (2.6%), and 46 (39.7%) patients were classified as having sarcopenia, sarcopenic obesity, and myosteatosis, respectively. The VAT–TAMA ratio (1.2 ± 0.7 vs 0.9 ± 0.5,
p
= 0.01) and the visceral to subcutaneous adipose tissue area ratio (1.3 ± 0.7 vs 0.9 ± 0.5,
p
= 0.04) were higher in sarcopenic patients than in the nonsarcopenic group. Preoperative sarcopenia and sarcopenic obesity were associated with shorter OS (
p
= 0.012 and
p
= 0.041, respectively), but not shorter DFS. Myosteatosis was neither associated with DFS nor OS. On multivariable analysis, sarcopenia was the only significant prognostic factor for OS (
p
= 0.039).
Conclusions
Preoperative sarcopenia assessed by CT is a poor prognostic factor for OS in pancreatic cancer patients after PD.
Key Points
•
Sarcopenia and sarcopenic obesity can be evaluated by abdominal CT on L3 level.
•
Patients with diabetes mellitus (DM) had lower sex-standardized subcutaneous adipose tissue area index and skeletal muscle density and higher visceral to subcutaneous adipose tissue area ratio than did those without DM.
•
Preoperative sarcopenia, sarcopenic obesity, and new-onset diabetes mellitus may predict poor overall survival in pancreatic cancer patients following pancreaticoduodenectomy.</description><subject>Adenocarcinoma</subject><subject>Adenocarcinoma - complications</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Adipose tissue</subject><subject>Aged</subject><subject>Attenuation</subject><subject>Body Composition</subject><subject>Cancer</subject><subject>Composition effects</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diagnostic Radiology</subject><subject>Evaluation</subject><subject>Female</subject><subject>Hepatobiliary-Pancreas</subject><subject>Humans</subject><subject>Imaging</subject><subject>Internal Medicine</subject><subject>Interventional Radiology</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Men</subject><subject>Middle Aged</subject><subject>Muscle, Skeletal - pathology</subject><subject>Muscles</subject><subject>Musculoskeletal system</subject><subject>Neuroradiology</subject><subject>Obesity</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Neoplasms - complications</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreaticoduodenectomy</subject><subject>Prognosis</subject><subject>Radiology</subject><subject>Retrospective Studies</subject><subject>Sarcopenia</subject><subject>Sarcopenia - complications</subject><subject>Sarcopenia - diagnostic imaging</subject><subject>Sarcopenia - pathology</subject><subject>Skeletal muscle</subject><subject>Statistical models</subject><subject>Survival</subject><subject>Tomography, X-Ray Computed</subject><subject>Tumors</subject><subject>Ultrasound</subject><subject>Vertebrae</subject><issn>0938-7994</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kU1vFSEUhonR2NvWP-DCkLhxM3r4GmBpmmpNmtiFXRMuc6g0c4cRZm7TnT9d9NaPuOiCwOE854XkIeQlg7cMQL-rAEJAB7wtza3s9BOyYVLwjoGRT8kGrDCdtlYekeNabwHAMqmfkyPBrZa9hQ35flUwz1j8kvZIqy-hVVPyNFXqa80h-QUHepeWr3TOudC8b_A40rqWfdr7kaaJzn4KBVtEoKEdsbSbJeG0VBrzOOa7NN38A-VhzQNOGJa8uz8lz6IfK7542E_I9YfzL2cX3eXnj5_O3l92QWi1dNwYL0VUW8VRaKYHDSbaLeOGQx-tVHGIKpqAWkqPxlhuhJSDUkPrW2_FCXlzyJ1L_rZiXdwu1YDj6CfMa3Vcyr7vJed9Q1__h97mtUztd44rEKCYFrxR_ECFkmstGN1c0s6Xe8fA_fTjDn5c8-N--XG6Db16iF63Oxz-jPwW0gBxAGprTTdY_r79SOwPGgidYA</recordid><startdate>20210401</startdate><enddate>20210401</enddate><creator>Peng, Yan-Chih</creator><creator>Wu, Chien-Hui</creator><creator>Tien, Yu-Wen</creator><creator>Lu, Tzu-Pin</creator><creator>Wang, Yu-Hsin</creator><creator>Chen, Bang-Bin</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7058-1427</orcidid></search><sort><creationdate>20210401</creationdate><title>Preoperative sarcopenia is associated with poor overall survival in pancreatic cancer patients following pancreaticoduodenectomy</title><author>Peng, Yan-Chih ; Wu, Chien-Hui ; Tien, Yu-Wen ; Lu, Tzu-Pin ; Wang, Yu-Hsin ; Chen, Bang-Bin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-288a43f5b52e3717d708f9b128206f945fdf5f8ce744ae88928344d55d2069a93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adenocarcinoma</topic><topic>Adenocarcinoma - complications</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - surgery</topic><topic>Adipose tissue</topic><topic>Aged</topic><topic>Attenuation</topic><topic>Body Composition</topic><topic>Cancer</topic><topic>Composition effects</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diagnostic Radiology</topic><topic>Evaluation</topic><topic>Female</topic><topic>Hepatobiliary-Pancreas</topic><topic>Humans</topic><topic>Imaging</topic><topic>Internal Medicine</topic><topic>Interventional Radiology</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Men</topic><topic>Middle Aged</topic><topic>Muscle, Skeletal - pathology</topic><topic>Muscles</topic><topic>Musculoskeletal system</topic><topic>Neuroradiology</topic><topic>Obesity</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Neoplasms - complications</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreaticoduodenectomy</topic><topic>Prognosis</topic><topic>Radiology</topic><topic>Retrospective Studies</topic><topic>Sarcopenia</topic><topic>Sarcopenia - complications</topic><topic>Sarcopenia - diagnostic imaging</topic><topic>Sarcopenia - pathology</topic><topic>Skeletal muscle</topic><topic>Statistical models</topic><topic>Survival</topic><topic>Tomography, X-Ray Computed</topic><topic>Tumors</topic><topic>Ultrasound</topic><topic>Vertebrae</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Peng, Yan-Chih</creatorcontrib><creatorcontrib>Wu, Chien-Hui</creatorcontrib><creatorcontrib>Tien, Yu-Wen</creatorcontrib><creatorcontrib>Lu, Tzu-Pin</creatorcontrib><creatorcontrib>Wang, Yu-Hsin</creatorcontrib><creatorcontrib>Chen, Bang-Bin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Peng, Yan-Chih</au><au>Wu, Chien-Hui</au><au>Tien, Yu-Wen</au><au>Lu, Tzu-Pin</au><au>Wang, Yu-Hsin</au><au>Chen, Bang-Bin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative sarcopenia is associated with poor overall survival in pancreatic cancer patients following pancreaticoduodenectomy</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2021-04-01</date><risdate>2021</risdate><volume>31</volume><issue>4</issue><spage>2472</spage><epage>2481</epage><pages>2472-2481</pages><issn>0938-7994</issn><eissn>1432-1084</eissn><abstract>Objectives
To analyze the effect of preoperative body composition on survival in patients with pancreatic cancer following pancreaticoduodenectomy (PD).
Methods
Between October 2005 and August 2018, 116 patients (68 men, 48 women, mean age 66.2 ± 11.9 years) diagnosed with pancreatic adenocarcinoma following PD were retrospectively enrolled. The preoperative CT on vertebral level L3 was assessed for total abdominal muscle area (TAMA), visceral adipose tissue area (VAT), subcutaneous adipose tissue area (SAT), and mean skeletal muscle attenuation (SMD). The clinical data and pathological findings of tumors were collected. The impact of these factors on disease-free survival (DFS) and overall survival (OS) was evaluated by the Kaplan–Meier method and by univariable and multivariable Cox proportional hazards models.
Results
The 3-year DFS and OS rates were 8% and 25%, respectively. Of 116 patients, 20 (17.2%), 3 (2.6%), and 46 (39.7%) patients were classified as having sarcopenia, sarcopenic obesity, and myosteatosis, respectively. The VAT–TAMA ratio (1.2 ± 0.7 vs 0.9 ± 0.5,
p
= 0.01) and the visceral to subcutaneous adipose tissue area ratio (1.3 ± 0.7 vs 0.9 ± 0.5,
p
= 0.04) were higher in sarcopenic patients than in the nonsarcopenic group. Preoperative sarcopenia and sarcopenic obesity were associated with shorter OS (
p
= 0.012 and
p
= 0.041, respectively), but not shorter DFS. Myosteatosis was neither associated with DFS nor OS. On multivariable analysis, sarcopenia was the only significant prognostic factor for OS (
p
= 0.039).
Conclusions
Preoperative sarcopenia assessed by CT is a poor prognostic factor for OS in pancreatic cancer patients after PD.
Key Points
•
Sarcopenia and sarcopenic obesity can be evaluated by abdominal CT on L3 level.
•
Patients with diabetes mellitus (DM) had lower sex-standardized subcutaneous adipose tissue area index and skeletal muscle density and higher visceral to subcutaneous adipose tissue area ratio than did those without DM.
•
Preoperative sarcopenia, sarcopenic obesity, and new-onset diabetes mellitus may predict poor overall survival in pancreatic cancer patients following pancreaticoduodenectomy.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>32974690</pmid><doi>10.1007/s00330-020-07294-7</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-7058-1427</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0938-7994 |
| ispartof | European radiology, 2021-04, Vol.31 (4), p.2472-2481 |
| issn | 0938-7994 1432-1084 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2446664226 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Adenocarcinoma Adenocarcinoma - complications Adenocarcinoma - pathology Adenocarcinoma - surgery Adipose tissue Aged Attenuation Body Composition Cancer Composition effects Diabetes Diabetes mellitus Diagnostic Radiology Evaluation Female Hepatobiliary-Pancreas Humans Imaging Internal Medicine Interventional Radiology Male Medical prognosis Medicine Medicine & Public Health Men Middle Aged Muscle, Skeletal - pathology Muscles Musculoskeletal system Neuroradiology Obesity Pancreatic cancer Pancreatic Neoplasms - complications Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Pancreaticoduodenectomy Prognosis Radiology Retrospective Studies Sarcopenia Sarcopenia - complications Sarcopenia - diagnostic imaging Sarcopenia - pathology Skeletal muscle Statistical models Survival Tomography, X-Ray Computed Tumors Ultrasound Vertebrae |
| title | Preoperative sarcopenia is associated with poor overall survival in pancreatic cancer patients following pancreaticoduodenectomy |
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