Preoperative sarcopenia determinants in pancreatic cancer patients

Carrara, Giulia; Pecorelli, Nicolò; Cobelli, Francesco De; Cristel, Giulia; Damascelli, Anna; Beretta, Luigi; Braga, Marco

doi:10.1016/j.clnu.2016.10.014

Cited by 57 publications

(45 citation statements)

References 32 publications

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“…Our findings echo the current literature, as young, male patients were found to have higher muscle mass than elderly female patients (21,24,29). Previous authors have identified age-dependent, or primary, sarcopenia as a confounder in studies focused on sarcopenia secondary to cancer, like ours.…”

Section: Discussionsupporting

confidence: 70%

“…TPA was significantly higher in young males, as was expected due to the gender and age difference (21,24). However, even after sub-group analysis was performed, neither TPA, BMI, nor BSA were significant predictors of overall survival.…”

Section: Discussionmentioning

confidence: 74%

“…Previous authors have identified age-dependent, or primary, sarcopenia as a confounder in studies focused on sarcopenia secondary to cancer, like ours. Age-dependent sarcopenia had to be effectively isolated as a confounder since it is highly prevalent in the elderly population, specifically in patients of AA (21). Interestingly, our cohort had 34 patients over the age of 75, yet despite a higher rate of sarcopenia in this group, TPA was not a significant predictor of acute complications.…”

Section: Discussionmentioning

confidence: 82%

“…The next best option is to use data from multiple studies using percentile based summative values. The literature currently uses a plethora of cohort-specific values, including using the lowest median, tertile, quartile, quintile, or standard deviation (19)(20)(21)23,24,27,28,(33)(34)(35)(36)(37)(38) in the study cohort. We validated our cohort's cutoff, by performing ROC curve analysis with regards to acute radiotoxicities which correlates to approximately a TPA of 500.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies investigated the association between pre-operative and post-operative TPA with outcomes in patients with pancreatic cancer (19)(20)(21)(22)(23)(24)(25). However, none have examined TPA prior to neoadjuvant therapy.…”

Section: Introductionmentioning

confidence: 99%

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

Jin¹,

Mellon²,

Frakes³

et al. 2018

J. Gastrointest. Oncol.

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Background: Total psoas area (TPA), a marker of sarcopenia, has been used as an independent predictor of clinical outcomes in gastrointestinal (GI) cancers as a proxy for frailty and nutritional status. Our study aimed to evaluate whether TPA, in contrast to traditional measurements of nutrition like body mass index (BMI) and body surface area (BSA), was predictive of outcomes in borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) patients receiving stereotactic body radiation therapy (SBRT). Methods: Retrospective analysis of an institutional review board approved database of 222 BRPC and LAPC treated with SBRT from 2009-2016 yielded 183 patients that met our selection criteria of pre-SBRT computed tomography (CT) imaging with an identifiable L4 vertebra. Once the L4 vertebral level was identified, the bilateral psoas muscles were manually contoured. This area was normalized by patient height, with units described in mm 2 /m 2 . Receiver operating characteristic (ROC) curves were generated for TPA, BMI, and BSA to elicit clinically relevant cutoffs. Regression and Kaplan-Meier analyses were used to correlate toxicity with survival functions.Results: Low TPA (OR =1.903, P=0.036) was predictive of acute toxicities, and only TPA was predictive of Grade 3 or higher acute toxicities (OR =10.24, P=0.007). Both findings were independent of tumor resectability. Pain (P=0.003), fatigue (P=0.040), and nausea (P=0.039) were significantly associated with low TPA. No association was identified between any measurement of nutritional status and the development of late toxicities, overall survival, local progression or local recurrence. However, BRPC patients survived longer (median =21.98 months) than their LAPC (median =16.2 months) counterparts (P=0.002), independent of nutritional status. Conclusions: TPA measurement is readily available and more specific than BMI or BSA as a predictor of acute radiotoxic complications following SBRT in BRPC/LAPC patients. A TPA of <500 mm 2 /m 2 is a clinically relevant cutoff that can direct physicians to address expected complications of pain, fatigue, and nausea. However, tumor resectability remains as the only predictor of overall survival in this cohort.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Jin¹,

Mellon²,

Frakes³

et al. 2018

J. Gastrointest. Oncol.

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Association Between Changes in Body Composition and Neoadjuvant Treatment for Pancreatic Cancer

et al. 2018

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The differential effects of sarcopenia and cachexia on overall survival for pancreatic ductal adenocarcinoma patients following pancreatectomy: A retrospective study based on a large population

et al. 2023

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Objectives Both cachexia and sarcopenia have been considered adverse predictors for prognosis in patients with pancreatic cancer; although sarcopenia and cachexia share some similarities, they are still defined as distinct nutritional conditions. We aimed to explore the differential impacts of sarcopenia and cachexia on prognosis for pancreatic ductal adenocarcinoma (PDAC) patients following radical excision. Methods From January 2015 to May 2022, 614 patients undergoing surgery for PDAC were retrospectively included. Sarcopenia was defined as the L3 total skeletal muscle index below 52.4 cm2/m2 (men) and 38.5 cm2/m2 (women). Cachexia was classified according to the following criteria: involuntary weight loss >5% over the past 6 months, or weight loss >2% and BMI <20 kg/m2, or weight loss >2% and sarcopenia. Results Of the 614 patients included in the analysis, 62% and 48% were diagnosed with sarcopenia and cachexia, respectively. Kaplan–Meier analysis showed that sarcopenia and/or cachexia were significantly associated with worse overall survival (OS) rather than worse recurrence‐free survival (RFS). Moreover, Cox regression analysis revealed that cachexia rather than sarcopenia was an adverse factor for OS in all PDAC patients. For poorly differentiated PDAC, both cachexia and sarcopenia were significantly associated with shorter OS. However, for moderately/well‐differentiated PADC, cachexia was an independent factor for adverse OS, but not sarcopenia. Conclusions Sarcopenia and cachexia have different effects on OS for PDAC patients undergoing radical excision. This difference may provide some important information for preoperative management.

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Preoperative sarcopenia determinants in pancreatic cancer patients

Cited by 57 publications

References 32 publications

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

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

Association Between Changes in Body Composition and Neoadjuvant Treatment for Pancreatic Cancer

The differential effects of sarcopenia and cachexia on overall survival for pancreatic ductal adenocarcinoma patients following pancreatectomy: A retrospective study based on a large population

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