Low skeletal muscle radiation attenuation and visceral adiposity are associated with overall survival and surgical site infections in patients with pancreatic cancer

Abstract

BackgroundCancer cachexia and skeletal muscle wasting are related to poor survival. In this study, quantitative body composition measurements using computed tomography (CT) were investigated in relation to survival, post‐operative complications, and surgical site infections in surgical patients with cancer of the head of the pancreas.MethodsA prospective cohort of 199 patients with cancer of the head of the pancreas was analysed by CT imaging at the L3 level to determine (i) muscle radiation attenuation (average Hounsfield units of total L3 skeletal muscle); (ii) visceral adipose tissue area; (iii) subcutaneous adipose tissue area; (iv) intermuscular adipose tissue area; and (v) skeletal muscle area. Sex‐specific cut‐offs were determined at the lower tertile for muscle radiation attenuation and skeletal muscle area and the higher tertile for adipose tissues. These variables of body composition were related to overall survival, severe post‐operative complications (Dindo–Clavien ≥ 3), and surgical site infections (wounds inspected daily by an independent trial nurse) using Cox‐regression analysis and multivariable logistic regression analysis, respectively.ResultsLow muscle radiation attenuation was associated with shorter survival in comparison with moderate and high muscle radiation attenuation [median survival 10.8 (95% CI: 8.8–12.8) vs. 17.4 (95% CI: 14.7–20.1), and 18.5 (95% CI: 9.2–27.8) months, respectively; P < 0.008]. Patient subgroups with high muscle radiation attenuation combined with either low visceral adipose tissue or age <70 years had longer survival than other subgroups (P = 0.011 and P = 0.001, respectively). Muscle radiation attenuation was inversely correlated with intermuscular adipose tissue (r p = −0.697, P < 0.001). High visceral adipose tissue was associated with an increased surgical site infection rate, OR: 2.4 (95% CI: 1.1–5.3; P = 0.027).ConclusionsLow muscle radiation attenuation was associated with reduced survival, and high visceral adiposity was associated with an increase in surgical site infections. The strong correlation between muscle radiation attenuation and intermuscular adipose tissue suggests the presence of ectopic fat in muscle, warranting further investigation. CT image analysis could be implemented in pre‐operative risk assessment to assist in treatment decision‐making.

Impact of sarcopenia in borderline resectable and locally advanced pancreatic cancer patients receiving stereotactic body radiation therapy

“…Outcome results in this analysis indicate that the median difference in survival in BRPC and LAPC patients is separated by a mere six months, like other findings in the current literature (35,70,71). Our study specifically included patients with only borderline resectable and locally advanced disease, which correlates with IIA, IIB, and III AJCC stages.…”

Effect of pretreatment psoas muscle mass on survival for patients with unresectable pancreatic cancer undergoing systemic chemotherapy

“…These results suggest that pretreatment PMI is useful for predicting outcomes for unresectable patients with APC undergoing systemic chemotherapy. Since the majority of previous reports have focused on the effect of skeletal muscle mass on survival for patients undergoing surgery, the results of the current study may be worth reporting (16,(19)(20)(21)(22)(23) (34) for baseline PMI may be attributed to the presence of advanced malignancies. Advanced malignancies themselves can cause severe muscle mass loss (17,18).…”

“…The proportion of SAEs of grade ≥3 in the PMI-H group was higher, as compared with in the PMI-L group, although the difference in the two groups did not reach significance in the present study. The majority of previous studies demonstrated that DSMM can increase the risk of development of surgery-associated complications for patients with PC (16,(19)(20)(21)(22)(23). Thus, caution for the development of SAEs during chemotherapy should be exercised, particularly in patients with PC with lower skeletal muscle mass.…”

“…A number of studies have demonstrated that DSMM could be an adverse predictor for patients with PC who were treated with surgical resection (16,(19)(20)(21)(22)(23). However, to the best of our knowledge, there are few reports regarding the impact of DSMM on survival in patients with unresectable APC undergoing systemic chemotherapy (24,25).…”

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

“…Fifteen studies [11,13,[20][21][22][23] [32], and 1 in China [26]. Among the included studies, 13 studies were directed at liver [11,13,[19][20][21][22][23][24][25][26][27][28][29] malignancy, 2 bile duct [30,31], 6 pancreas [12,14,[32][33][34][35], 2 periampullary [36,37], 4 periampullary and pancreas [38][39][40][41], and 1 hepatopancreatobiliary [42]. The sample size ranged from 67 to 763.…”