Impact of Osteopenia on Oncologic Outcomes After Curative Resection for Pancreatic Cancer

Abstract

Background/Aim: We evaluated the relationship between low bone mineral density (BMD), also called osteopenia, and prognosis in patients who underwent resection for pancreatic cancer (PC). Patients and Methods: We enrolled 91 consecutive patients who underwent curative resections for PC between May 2009 and January 2019. Their BMDs were measured at the Th11 vertebra using computed tomography. Patients were then divided by ageadjusted standard BMD values into the osteopenia group (n=34) and the non-osteopenia group (n=57). Their overall survival (OS) and recurrence-free survival (RFS) were compared (log-rank test). Results: The two groups did not differ in age, BMI, tumor marker, operation time, blood loss, postoperative complications or stage. The osteopenia group had significantly worse 3-year rates for OS (46% vs. 30%, p=0.04) and RFS (41% vs. 26%, p=0.01). In multivariate analysis, osteopenia was an independent prognostic factor for RFS (HR=2.16, p=0.01). Conclusion: Osteopenia is an adverse prognostic factor for patients with resected PC.

Prognostic value of preoperative low bone mineral density in patients with digestive cancers: a systematic review and meta-analysis

“…After contacting the original authors, we included an additional study. Finally, 11 studies (2230 patients) were included for the meta-analysis [23][24][25][26][27][28][29][30][31][32][33].…”

“…Table 1 shows the characteristics of the included studies [23][24][25][26][27][28][29][30][31][32][33]. Of the 11 studies, three studies focused on pancreatic cancer [25,26,28], two on colorectal liver metastases [29,30], two on extrahepatic cholangiocarcinoma [24,32], one on esophageal cancer [31], one on colon cancer [33], and two on hepatocellular carcinoma [23,27]. Six studies adopted cutoff values for BMD from previous studies [23,25,33,[27][28][29], while the other five studies adopted their own cutoff values [24,26,[30][31][32].…”

“…Of the 11 studies, three studies focused on pancreatic cancer [25,26,28], two on colorectal liver metastases [29,30], two on extrahepatic cholangiocarcinoma [24,32], one on esophageal cancer [31], one on colon cancer [33], and two on hepatocellular carcinoma [23,27]. Six studies adopted cutoff values for BMD from previous studies [23,25,33,[27][28][29], while the other five studies adopted their own cutoff values [24,26,[30][31][32]. There was no statistically significant difference in the association between low BMD and normal BMD in five studies where patients received neoadjuvant chemotherapy [25,26,[29][30][31].…”

“…Six studies adopted cutoff values for BMD from previous studies [23,25,33,[27][28][29], while the other five studies adopted their own cutoff values [24,26,[30][31][32]. There was no statistically significant difference in the association between low BMD and normal BMD in five studies where patients received neoadjuvant chemotherapy [25,26,[29][30][31]. The risk of bias for study participation, study attrition, outcome measurements, and statistical analysis were low.…”

“…(%) Cutoff values of BMD (HU) (male/female) Neoadjuvant chemotherapy no. (%) Sarcopenia QUIPS Miyachi [ 23 ] 2019 HCC 465 69 273 (59) 160 NR PMI Low Yao [ 24 ] 2019 ECC 181 68 124 (69) 169 NR PMI Moderate Motomura [ 25 ] 2020 PC 91 75 34 (37) 308.82 − 2.49*age / 311.84 − 2.41*age 4/91 (4) SMI Low Sharshar [ 26 ] 2020 PC 275 71 136 (50) 137.5/128.8 32/275 (11) PMI Moderate Toshima [ 27 ] 2020 HCC 193 58 103 (53) 308.82 − 2.49*age / 311.84 − 2.41*age NR SMA Low Abe [ 28 ] 2021 PC 56 72 27 (48) 160 0/56 (0) SMI Low Furukawa [ 29 ] 2021 CRLM 118 68 66 (56) 308.82 − 2.49*age / 311.84 − 2.41*age 41/118 (35) PMA Low Ikuta [ 30 ] 2021 CRLM 281 66 143 (51) 141 168/281 (60) NR …”