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 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 andp= 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.

Automated summary

Preoperative sarcopenia assessed by CT is a poor prognostic factor for overall survival in pancreatic cancer patients after pancreaticoduodenectomy (PD).