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Sarcopenia as a Predictor of Survival in Patients with Pancreatic Adenocarcinoma After Pancreatectomy

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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.

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Authors and Affiliations

  1. Department of Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel

    Hadass Rom MD, Yael Berger MD, Daniel Benchimol MD, Hanoch Kashtan MD & Eran Sadot MD

  2. Department of Radiology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel

    Shlomit Tamir MD

  3. Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands

    Jeroen L. A. Van Vugt MD, PhD

  4. Department of Oncology, Davidoff Cancer Center, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel

    Gali Perl MD & Baruch Brenner MD

  5. Institute of Pathology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel

    Sara Morgenstern MD & Ana Tovar MD

  6. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Hadass Rom MD, Shlomit Tamir MD, Yael Berger MD, Hanoch Kashtan MD & Eran Sadot MD

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Correspondence to Eran Sadot MD.

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Rom, H., Tamir, S., Van Vugt, J.L.A. et al. Sarcopenia as a Predictor of Survival in Patients with Pancreatic Adenocarcinoma After Pancreatectomy. Ann Surg Oncol 29, 1553–1563 (2022). https://doi.org/10.1245/s10434-021-10995-y

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  • DOI: https://doi.org/10.1245/s10434-021-10995-y

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