Prognostic Value of Sarcopenia and Myosteatosis in Patients with Resectable Pancreatic Ductal Adenocarcinoma

Abstract

Objective The clinical relevance of myosteatosis has not been well evaluated in patients with pancreatic ductal adenocarcinoma (PDAC), although sarcopenia has been extensively researched. Therefore, we evaluated the prognostic value of muscle quality, including myosteatosis, in patients with resectable PDAC treated surgically. Materials and Methods We retrospectively evaluated 347 patients with resectable PDAC who underwent curative surgery (mean age ± standard deviation, 63.6 ± 9.6 years; 202 male). Automatic muscle segmentation was performed on preoperative computed tomography (CT) images using an artificial intelligence program. A single axial image of the portal phase at the inferior endplate level of the L3 vertebra was used for analysis in each patient. Sarcopenia was evaluated using the skeletal muscle index, calculated as the skeletal muscle area (SMA) divided by the height squared. The mean SMA attenuation was used to evaluate myosteatosis. Diagnostic cutoff values for sarcopenia and myosteatosis were devised using the Contal and O’Quigley methods, and patients were classified according to normal (nMT), sarcopenic (sMT), myosteatotic (mMT), or combined (cMT) muscle quality types. Multivariable Cox regression analyses were conducted to assess the effects of muscle type on the overall survival (OS) and recurrence-free survival (RFS) after surgery. Results Eighty-four (24.2%), 73 (21.0%), 75 (21.6%), and 115 (33.1%) patients were classified as having nMT, sMT, mMT, and cMT, respectively. Compared to nMT, mMT and cMT were significantly associated with poorer OS, with hazard ratios (HRs) of 1.49 (95% confidence interval, 1.00–2.22) and 1.68 (1.16–2.43), respectively, while sMT was not (HR of 1.40 [0.94–2.10]). Only mMT was significantly associated with poorer RFS, with an HR of 1.59 (1.07–2.35), while sMT and cMT were not. Conclusion Myosteatosis was associated with poor OS and RFS in patients with resectable PDAC who underwent curative surgery.

Association between preoperative sarcopenia and prognosis of pancreatic cancer after curative-intent surgery: a updated systematic review and meta-analysis

“…After removing duplicates and unrelated studies, 119 full-text studies were assessed for eligibility. Eventually, 23 studies were eligible for qualitative synthesis after careful examination [ 14 – 17 , 28 – 46 ]. The detailed flow diagram is shown in Fig.…”

“…Most patients with pancreatic cancer were prone to skeletal muscle depletion, leading to reduced tolerance for postoperative adjuvant therapy [ 12 , 13 ]. Several recent studies have attempted to investigate the effect of sarcopenia on the prognosis of pancreatic cancer, but the outcomes of these studies have been more or less controversial [ 14 – 17 ]. Evidence needs to be updated, so the aim of this systematic review and meta-analysis is to clarify the relationship between preoperative sarcopenia and the prognosis of pancreatic cancer.…”

Effect of sarcopenia on survival in patients after pancreatic surgery: a systematic review and meta-analysis

“…The sample sizes ranged from 83–763, and these studies had an average quality scoring of 7.4 stars. In total, multivariate OS results for 16 studies [13 studies ( 13–16 , 22 , 23 , 25–31 ) were assessed for univariate estimates only] and multivariate PFS results for 6 studies ( 16 , 23 , 26 , 30 , 31 , 33 ) were analyzed [five studies ( 16 , 23 , 26 , 30 , 31 )were assessed for univariate estimates only]. The three main surgical procedures performed in the included studies were distal pancreatectomy (DP), total pancreatectomy (TP), and pancreaticoduodenectomy (PD).…”

The Augural Interplay of Myosteatosis and Gamma-Glutamyltransferase in Patients Undergoing Comprehensive Surgical Intervention for Cholangiocarcinoma

“…Myosteatosis, the aberrant agglomeration of triglycerides-neutral fats-within muscle tissues, is a recurrent body composition deviation discernible in patients beleaguered by malignant neoplasms, inclusive of gastric cancer, pancreatic cancer, and pulmonary cancer [9][10][11][12]. Academic endeavours have elucidated that patients suffering from pancreatic cancer concurrent with myosteatosis endure abbreviated survival spans and encounter less favourable prognoses [9]. Our anterior meta-analysis endeavours have also laid bare the palpable in uence of myosteatosis on the prognosis of cholangiocarcinoma patients, heralding curtailed overall survival (OS) and recurrence-free survival (RFS).…”