Preoperative Osteopenia Is Associated with Significantly Shorter Survival in Patients with Perihilar Cholangiocarcinoma

Abstract

Background: Osteopenia is defined as low bone mineral density (BMD) and has been shown to be associated with outcomes of patients with various cancers. The association between osteopenia and perihilar cholangiocarcinoma is unknown. The aim of this study was to evaluate osteopenia as a prognostic factor in patients with perihilar cholangiocarcinoma. Methods: A total of 58 patients who underwent surgery for perihilar cholangiocarcinoma were retrospectively analyzed. The BMD at the 11th thoracic vertebra was measured using computed tomography scan within one month of surgery. Patients with a BMD < 160 HU were considered to have osteopenia and b BMD ≥ 160 did not have osteopenia. The log-rank test was performed for survival using the Kaplan–Meier method. After adjusting for confounding factors, overall survival was assessed by Cox′s proportional-hazards model. Results: The osteopenia group had 27 (47%) more females than the non-osteopenia group (p = 0.036). Median survival in the osteopenia group was 37 months and in the non-osteopenia group was 61 months (p = 0.034). In multivariable analysis, osteopenia was a significant independent risk factor associated with overall survival in patients with perihilar cholangiocarcinoma (hazard ratio 3.54, 95% confidence interval 1.09–11.54, p = 0.036), along with primary tumor stage. Conclusions: Osteopenia is associated with significantly shorter survival in patients with perihilar cholangiocarcinoma.

Preoperative Bone Loss Predicts Decreased Survival Associated with Microvascular Invasion after Resection of Hepatocellular Carcinoma

“…Preoperative CT scan images at the third lumbar spine (L3) level were used to measure the psoas muscle mass index (PMI), which indicates low skeletal muscle mass. PMI was calculated by dividing the cross-sectional area of the psoas major muscle by the square of its height (cm 2 /m 2 ) [ 6 ]. The cutoff values for PMI for gender differences (6.36 for men and 3.92 for women) were set as previously reported by Hamaguchi et al [ 18 ].…”

“…Osteopenia, in which bone mineral density (BMD) becomes lower than normal but not as severely low as in osteoporosis, has recently received attention for its association with hepatobiliary cancer [ 6 , 7 , 8 ]. Dual-energy X-ray absorptiometry (DXA) is the gold standard for evaluating BMD, but computed tomography (CT) scan-based attenuation values are widely used for the preoperative staging of hepatocellular carcinoma patients and are increasingly used to characterize BMD [ 9 ].…”

“…Sharma et al recently found that low BMD, a surrogate marker for bone loss, is independently associated with early deconditioning markers that precede sarcopenia [ 10 ]. Reports associated with several types of malignancies showed that osteopenia is associated with decreased survival [ 6 , 11 , 12 , 13 ]. Bone loss with age was reported to be more common in females as a consequence of post-menopausal findings.…”

The Prognostic Impact of Preoperative Osteopenia in Patients with Colorectal Cancer

“…In fact, there are several reports showing the poor prognostic impact of osteopenia in hepatocellular carcinoma, cholangiocarcinoma, pancreatic cancer, and esophageal cancer. [13][14][15][16][17][18] With regard to CRC, there are only a few reports with small cohort sizes. 12,13 This study aimed to assess the impact of preoperative osteopenia on the recurrence and survival of patients with CRC.…”

“…In fact, there are several reports showing the poor prognostic impact of osteopenia in hepatocellular carcinoma, cholangiocarcinoma, pancreatic cancer, and esophageal cancer. 13–18 With regard to CRC, there are only a few reports with small cohort sizes. 12,13…”