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

Abstract

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.

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

“…Of note, this study included both benign and malignant pancreatic diseases, thereby incorporating all possible reasons for pancreatic resection. Consistent with most previous study findings ( 13 , 32 ), the present meta-analysis demonstrates that sarcopenia was associated with a poor prognosis in patients who underwent pancreatic surgery. Patients with sarcopenia have significantly shorter long-term OS in univariate or multivariate analyses than those without sarcopenia.…”

“…We identified 695 studies in the databases. After excluding studies that failed to meet the inclusion criteria and duplicate articles, 16 studies ( 13–16 , 22–33 ) met the inclusion requirements for the analyses. A meta-analysis and systematic review were performed of these 16 studies.…”

“…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 influence of sarcopenia on the postoperative OS of patients with PDAC was reported in nine studies ( 13 , 22 , 23 , 25 , 28–31 , 33 ). The aggregated multivariate HR analysis indicated that sarcopenia was associated with lower postoperative OS of patients with PDAC (HR 1.47; 95% CI 1.27–1.72, I 2 = 44.6%; Figure 7 ).…”

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.…”