The prognostic impact of preoperative body composition in perihilar and intrahepatic cholangiocarcinoma

Abstract

Cholangiocarcinoma (CCA) is a rare but highly aggressive malignancy of the biliary system. Although it is amenable to surgical resection in early disease, outcomes are frequently dismal. Here, we investigated the prevalence of body composition (BC) alterations and their prognostic role for surgical patients with intrahepatic (iCCA) and perihilar (pCCA) disease. Patients undergoing curative‐intent surgery for iCCA or pCCA between 2010 and 2019 at University Hospital Aachen were included. Axial computed tomography images were retrospectively assessed with a segmentation tool (3D Slicer) at the level of the third lumbar vertebra to determine lumbar skeletal muscle (SM) index, mean SM radiation attenuation, and visceral fat area. The related BC pathologies sarcopenia, myosteatosis, visceral obesity, and sarcopenic obesity were determined using previously described cutoffs. A total of 189 patients (86 with iCCA, 103 with pCCA) were included. Alterations of BC were highly prevalent in iCCA and pCCA, respectively: sarcopenia, 33% (28/86) and 39% (40/103); myosteatosis, 66% (57/86) and 66% (68/103); visceral obesity, 56% (48/86) and 67% (69/103); sarcopenic obesity, 11% (9/86) and 17% (17/103). Sarcopenia and myosteatosis did not have a significant prognostic role for disease‐free survival (DFS) and overall survival (OS). Patients with iCCA with sarcopenic obesity (n = 9) had significantly shorter OS than patients without sarcopenic obesity (n = 7; log‐rank p = 0.002; median OS, 11 months and 31 months; 1‐year mortality, 55.6% [5/9] and 22% [17/77]; 5‐year mortality, 88.9% [8/9] and 61% [47/77], respectively). In multivariable analysis, only tumor‐related risk factors remained prognostic for DFS and OS. Sarcopenic obesity may affect clinical outcomes after curative‐intent surgery for iCCA, indicating that imaging‐based analysis of BC may hold prognostic value for long‐term survival and could aid preoperative patient selection.

Body Composition of Patients Undergoing Radical Cystectomy for Bladder Cancer: Sarcopenia, Low Psoas Muscle Index, and Myosteatosis Are Independent Risk Factors for Mortality

“…The most common values and thresholds that could be found in the literature were used for sarcopenia [ 14 , 18 , 39 , 40 ], PMI [ 17 ], myosteatosis [ 14 , 18 , 19 , 24 ], SFI [ 11 ] and visceral obesity [ 41 ]. For the VFI and VSR, no suitable validated thresholds were found.…”

“…Sarcopenia, being the most commonly assessed body composition parameter, was found to be a predictor for survival in several malignancies including ovarian cancer, colorectal cancer, cholangiocarcinoma, gastric cancer, pancreatic cancer, prostate cancer, and BC [ 13 , 16 , 21 , 22 , 23 , 24 ]. Similarly, the psoas muscle index and myosteatosis are prognostic factors in different tumor entities including urologic tumors [ 10 , 17 , 25 , 26 , 27 , 28 , 29 ].…”

Body composition is associated with disease aetiology and prognosis in patients undergoing resection of intrahepatic cholangiocarcinoma

“…As previously described, 9,17 an axial CT image at the level of the third lumbar vertebra from the most recent CT image before surgery was analyzed semi‐automatically with 3D Slicer 18 and the Workstation SlicerCIP extension, body composition module (version 4.10.2). Attenuation values from −29 to 150 Hounsfield units (HU) defined skeletal muscle 19 .…”

“…It is currently unclear whether these observations can be translated into oncological settings, where the typical phenotype of cachexia and sarcopenia is the most frequently described alteration. Our group recently reported that sarcopenic obesity may hold value for overall survival in iCCA in a different patient cohort from a German tertiary centre 9 . This publication, despite a lower sample size, showed a high prevalence of body composition pathologies in patients with iCCA and perihilar CCA 9 …”

“…Our group recently reported that sarcopenic obesity may hold value for overall survival in iCCA in a different patient cohort from a German tertiary centre 9 . This publication, despite a lower sample size, showed a high prevalence of body composition pathologies in patients with iCCA and perihilar CCA 9 …”