Computed Tomographic Sarcopenia in Pancreatic Cancer: Further Utilization to Plan Patient Management

Abstract

Purpose The presence of a sarcopenia adversely affects the prognosis of patients with pancreatic cancer. There is an emerging role for using computed tomography (CT) to calculate skeletal muscle index (SMI) and the presence of sarcopenia. The aim of this study was to assess if detecting ‘computed tomographic sarcopenia’ is feasible and can contribute to the management of patients with locally advanced pancreatic cancer (LAPC). Methods Patients diagnosed with LAPC referred for endoscopic ultrasound-guided biopsy (EUS-B) by our regional cancer network were identified. Age, body mass index (BMI), and Eastern Cooperative Oncology Group performance status (ECOG-PS) were noted. CT images were analysed for SMI and the presence of sarcopenia. Decision outcomes on receiving chemotherapy or not were collected from the regional oncology database. Results In total, 51/204 (25%) patients with LAPC who underwent EUS-B were not given chemotherapy and received best supportive care (BSC) only. The prevalence of sarcopenia (p = 0.0003), age ≥ 75 years old (p = 0.03), and ECOG-PS 2–3 (p = 0.01) were significantly higher in the patients receiving BSC only. Logistic regression analysis demonstrated that SMI was the only independent associated factor identifying patients with LAPC who were treated with BSC only and not chemotherapy after adjusting for age and ECOG-PS. Conclusion Our study has shown that computed tomographic skeletal muscle analysis at the time of a diagnostic CT for patients with pancreatic cancer is feasible and can detect sarcopenia and malnourished patients who are much less likely to take up chemotherapy. These patients could be triaged to oncology assessment prior to EUS-B to avoid unnecessary investigations.

Relationship between circulating tumour DNA and skeletal muscle stores at diagnosis of pancreatic ductal adenocarcinoma: a cross-sectional study

“…The lack of difference in BMI between participants with low or normal SMI reinforces the notion that basic anthropometric methods cannot be relied upon to distinguish those at risk of skeletal muscle depletion, which can occur independent of change in body weight 53 , 80 , 81 . Presence of low SMI was strongly associated with female gender in this study, but this remains contentious in the PDAC literature where most analyses are univariate; some studies report a similar finding 82 , 83 , however in other studies no gender differences are seen 42 , 84 . Classification of gender as a risk factor for low SMI has potential importance in screening of PDAC patients to identify those most vulnerable to skeletal muscle depletion, but there is a dearth of multivariate investigations of factors influencing SMI in PDAC patients.…”

The impacts of sarcopenia on outcomes of patients with left-sided colon or rectal cancer after curative surgery

“…It has been hypothesized that sarcopenia identi ed by CT could be used as a reliable but modi able factor for postoperative complications, deaths and cancer recurrence after curative surgery. By improving nutritional status of patients before surgery, we could signi cantly improve short-term [20] and long-term outcomes [21]. As known to us, left-sided colon cancer and rectal cancer are the most common among colorectal cancers.…”

“…gastric cancer[8], bladder cancer [9], breast cancer [10], pancreatic cancer [21]. And a series of studies have investigated the impacts of preoperative sarcopenia on short-term and long-term outcomes of patients with colorectal cancer.…”

The impact of sarcopenia on the outcome of patients with left-sided colon and rectal cancer after curative surgery

“…It has been hypothesized that sarcopenia identified by CT could be used as a reliable but modifiable factor for postoperative complications, deaths and cancer recurrence after curative surgery. By improving the nutritional status of patients before surgery, postoperative outcomes could be significantly improved [ 24 , 25 ]. Left-sided colon cancer and rectal cancer are the most common types of CRC.…”

“…The results of this study were consistent with those of some previous studies. In fact, sarcopenia has been reported as a risk factor for patients with various cancers, such as hepatocellular carcinoma [ 7 ], gastric cancer [ 9 ], bladder cancer [ 10 ], breast cancer [ 11 ], and pancreatic cancer [ 25 ]. A series of studies have investigated the impacts of preoperative sarcopenia on the short-term and long-term outcomes of patients with CRC.…”