Sarcopenia as a Predictor of Survival in Patients with Pancreatic Adenocarcinoma After Pancreatectomy
2Radiology, Beilinson Hospital, Rabin Medical Center, Israel
3Surgery, Erasmus MC University Medical Center, Netherlands
4Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Israel
5Pathology, Institute of Pathology, Beilinson Hospital, Rabin Medical Center, Israel
6Sackler Faculty of Medicine, Tel Aviv University, Israel
Objective: To determine if sarcopenia can potentially predict worse survival after resection of pancreatic ductal adenocarcinoma (PDAC).
Background: Sarcopenia is correlated with poor outcome 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.
Methods: Preoperative cross-sectional CT 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 sample included 111 patients, 47% female, of median age 67 years (range: 35-87) and median body mass index 23kg/m2 (range: 16-40); 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.
Presented at the American Colleges of Surgeons Clinical Congress, Online, October 2020.