Impact of preoperative body compositions on survival following resection of biliary tract cancer

Yoon, Seung Bae; Choi, Moon Hyung; Song, Minju; Lee, Ju Hyun; Lee, In Seok; Lee, Myung Ah.; Hong, Tae Ho; Jung, Eun Sun; Choi, Myung‐Gyu

doi:10.1002/jcsm.12431

Cited by 26 publications

(33 citation statements)

References 36 publications

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“…However, sarcopenia was significantly associated with poor prognosis in the univariate analysis. Concordant with our data, Yoon et al, who analyzed the significance of sarcopenia on BTC, showed that a low skeletal muscle index was not associated with improved survival in a multivariate analysis ( 30 ). It is possible that BTC is more affected by tumor specific factors rather than patient related factors such as sarcopenia.…”

Section: Discussionsupporting

confidence: 92%

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Prognostic Significance of Sarcopenia in Advanced Biliary Tract Cancer Patients

et al. 2020

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Background: Sarcopenia, systemic inflammation, and low muscularity significantly impact the survival of cancer patients. However, few studies have investigated how sarcopenia and systemic inflammation affect the prognosis of biliary tract cancer with distant metastasis. In this study, we investigated the association between sarcopenia with systemic inflammation and prognosis of metastatic biliary tract cancer. Materials and Methods: Data collected from 353 metastatic biliary tract cancer patients from 2007 to 2016 were analyzed. To evaluate the skeletal muscle mass, computed tomography images at the upper level of the third lumbar vertebra (L3) were used. Sarcopenia was defined using the Japan Society of Hepatology guideline; L3 muscle index <42 cm 2 /m 2 for male and <38 cm 2 /m 2 for female patients. Systemic inflammation was evaluated using the neutrophil lymphocyte ratio (NLR). Patients with NLR > 3 were categorized into the inflammatory category. The overall survival (OS) and progression free survival (PFS) were analyzed. Subgroup analysis was performed on those who received gemcitabine/cisplatin (GP) chemotherapy and depending on the presence of sarcopenia and inflammation. Results: Patients with sarcopenia showed lesser 1-year OS than those without (25.5 vs. 38.2%, p = 0.019). The patients with high NLR (NLR > 3) were associated with a shorter OS than were those with a low NLR (NLR ≤ 3) (21.0 vs. 52.8%, p < 0.001). Based on these results, we categorized the patients into three groups; sarcopenia accompanied by high NLR, no sarcopenia and low NLR, and either sarcopenia or high NLR. The OS of patients was well-stratified according to this grouping (1-year OS; 18.3 vs. 30.3 vs. 55.8%, p < 0.001). Concordant with OS results, the PFS was well-stratified based on the presence of either sarcopenia or high NLR (Sarcopenia; 9.5 vs. 19.4%, p < 0.001, NLR; 10.0 vs. 23.4%, p < 0.001). The PFS was significantly associated with high NLR and sarcopenia (1-year PFS; 7.8 vs. 13.0 vs. 27.9%, p < 0.001). Conclusion: Sarcopenia with inflammation was associated with inferior OS and PFS. In addition, sarcopenia accompanied by inflammation was associated with poor prognosis. Conservative treatments such as nutritional support, exercise, and pharmacologic intervention could help metastatic biliary tract cancer patients to overcome sarcopenia and the inflammatory status.

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Section: Discussionsupporting

confidence: 92%

“…Yoon et al used two ways to evaluate the sarcopenia status of BTC patients; skeletal muscle attenuation; and index. They also suggested that those with low skeletal muscle attenuation had negative influence on survival when compared to those that underwent resection for BTC ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Sarcopenia in Advanced Biliary Tract Cancer Patients

et al. 2020

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“…Along with these analyses suggesting a use of L3SMI, L3PMI, and MMA as stand-alone markers for estimating patients’ overall survival, we further tested different combinations of L3SMI/MMA as prognostic markers, revealing that patients with low muscle mass and low muscle quality had the worst prognosis of all patients ( Figure 6 ). Interestingly, these data are in line with a recent analysis by Yoon et al, demonstrating that both reduced muscle mass and muscle quality are indicative for an impaired prognosis of patients following the resection of biliary tract cancer [ 23 ]. In the past, reduced muscle mass, e.g., indicated by a reduced L3SMI or L3PMI, was used to assess the presence of sarcopenia.…”

Section: Discussionsupporting

confidence: 89%

Sarcopenia and Myosteatosis as Prognostic Markers in Patients with Advanced Cholangiocarcinoma Undergoing Palliative Treatment

Jördens

Wittig

Heinrichs

et al. 2021

JCM

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Background: Cholangiocarcinoma (CCA) represents the second most common primary liver cancer and is characterized by a very poor outcome, but reliable prognostic markers are largely missing. Sarcopenia, the progressive loss of muscle mass and strength, as well as myosteatosis have been associated with an unfavorable outcome in several clinical conditions, including cancer. Here, we evaluated the prognostic relevance of sarcopenia and myosteatosis using routine abdominal CT (computed tomography) scans in advanced stage CCA patients undergoing palliative treatment. Methods: Routine abdominal CT scans were used to assess the skeletal muscle and the psoas muscle index (L3SMI/L3PMI) at the level of the third lumbar vertebra as radiological indices for sarcopenia as well as the mean skeletal muscle attenuation (MMA) as a surrogate for myosteatosis. Results were correlated with clinical data and outcomes. Results: Using a calculated optimal cut-off value of 71.95 mm2/cm, CCA patients with an L3SMI value below this cut-off showed a significantly reduced median overall survival (OS) of only 250 days compared to 450 days in patients with a higher L3SMI. Moreover, the median OS of CCA patients with an L3PMI above 6345 mm2/cm was 552 days compared to 252 days in patients with a lower L3PMI. Finally, CCA patients with an MMA above 30.51 Hounsfield Units survived significantly longer (median OS: 430 days) compared to patients with an MMA value below this ideal cut-off (median OS: 215 days). The prognostic relevance of L3SMI, L3PMI, and MMA was confirmed in uni- and multivariate Cox regression analyses. Conclusion: Routine abdominal CT scans represent a unique opportunity to evaluate sarcopenia as well as myosteatosis in advanced CCA patients. We identified the L3SMI/L3PMI as well as the MMA as negative prognostic factors in CCA patients undergoing palliative therapy, arguing that the “opportunistic” evaluation of these parameters might yield important clinical information in daily routine.

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“…Sarcopenia is associated with multiple medical issues such as disability, prolonged hospitalization, increased inflammatory marker levels, postoperative complications, falls, and poor quality of life [8][9][10][11]. In addition, using computed tomography (CT)-based analysis, which is one of the most commonly used methods for evaluating muscle mass, recent studies reported that sarcopenia is a risk factor associated with poor survival of patients with various types of tumors [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Impact of Sarcopenia and Skeletal Muscle Loss During Neoadjuvant Chemoradiotherapy in Esophageal Cancer

Yoon

Ahn

et al. 2020

Cancers

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Backgrounds: The relationship between sarcopenia, characterized by loss of muscle mass and strength, and survival outcomes of esophageal cancer is controversial. This study aimed to assess the effect of sarcopenia and skeletal muscle loss on overall survival (OS) and recurrence-free survival (RFS) of esophageal cancer patients. Methods: We retrospectively collected the medical records of 248 male patients diagnosed with squamous cell esophageal cancer and who underwent neoadjuvant chemoradiotherapy (NACRT) followed by surgery. We measured the cross-sectional area of the skeletal muscle at the L3 vertebra level using computed tomography images and calculated the skeletal muscle index (SMI). Sarcopenia was defined as SMI <52.4 cm2/m2, and excessive muscle loss was defined as SMI change <−10.0%/50 days during NACRT. Moreover, laboratory test results, such as albumin, prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) before and after NACRT, were collected. Results: In the univariable Cox analysis, pre- (p = 0.689) and post-radiotherapy (RT) sarcopenia (p = 0.669) were not associated with OS. However, excessive muscle loss had a significant association with OS in both the univariable and multivariable analyses (all p = 0.001). Excessive muscle loss was also related to RFS in both the univariable (p = 0.011) and multivariable (p = 0.022) Cox analysis. Patients with excessive muscle loss had significantly lower levels of post-RT albumin (p < 0.001) and PNI (p < 0.001), higher levels of post-RT NLR (p = 0.031) and PLR (p = 0.071), larger decrease in albumin (p < 0.001) and PNI (p < 0.001) after NACRT, and larger increase in NLR (p = 0.051) and PLR (p = 0.088) after NACRT than in those with non-excessive muscle loss. Conclusion: Excessive muscle loss rather than pre- and post-RT sarcopenia was a significant prognostic factor for OS and RFS, and it was also related to nutritional and inflammatory markers.

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Impact of preoperative body compositions on survival following resection of biliary tract cancer

Cited by 26 publications

References 36 publications

Prognostic Significance of Sarcopenia in Advanced Biliary Tract Cancer Patients

Prognostic Significance of Sarcopenia in Advanced Biliary Tract Cancer Patients

Sarcopenia and Myosteatosis as Prognostic Markers in Patients with Advanced Cholangiocarcinoma Undergoing Palliative Treatment

Prognostic Impact of Sarcopenia and Skeletal Muscle Loss During Neoadjuvant Chemoradiotherapy in Esophageal Cancer

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