The Prognostic Value of Low Muscle Mass in Pancreatic Cancer Patients: A Systematic Review and Meta-Analysis

Abstract

Low muscle mass is associated with reduced survival in patients with different cancer types. The interest in preoperative sarcopenia and pancreatic cancer has risen in the last decade as muscle mass loss seems to be associated with poorer survival, higher postoperative morbidity, and mortality. The aim of the present study was to review the literature to compare the impact of low muscle mass on the outcomes of patients undergoing surgery for pancreatic adenocarcinoma. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and 10 articles were analyzed in detail and included in the meta-analysis. Data were retrieved on 2811 patients undergoing surgery for pancreatic cancer. Meta-analysis identified that patients with low muscle mass demonstrated a significantly reduced OS when compared to patients without alterations of the muscle mass (ROM 0.86; 95% CI: 0.81–0.91, p < 0.001), resulting in a 14% loss for the former. Meta-analysis failed to identify an increase in the postoperative complications and length of stay of patients with low muscle mass. Our analysis confirms the role of low muscle mass in influencing oncologic outcomes in pancreatic cancer. Its role on surgical outcomes remains to be established.

Effect of Body Composition Change during Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma

“…Sarcopenia is characterized by the progressive and systemic loss of skeletal muscle mass and strength, leading to adverse outcomes, such as reduced quality of life and mortality [5]. There have been reports that sarcopenia affects the prognosis of various malignancies [26][27][28]. We have also reported that sarcopenia is a poor prognostic factor in patients with unresectable esophageal cancer [7] and that sarcopenic obesity is a poor prognostic factor in patients with resectable esophageal cancer [29].…”

Chest computed tomography‐derived muscle mass and quality indicators, in‐hospital outcomes, and costs in older inpatients

“…The association between CT‐derived low muscle mass and mortality has been widely reported in patients with cancer, 27 including lung cancer 28 and pancreatic cancer 29 . Although the association between low muscle mass and mortality in older adults has also been well‐established in previous studies, 30–32 most of these studies measured muscle mass with bioimpedance analysis or dual‐energy X‐ray absorptiometry instead of CT scan.…”

Recent Advances in Pancreatic Neoplasms

“…This Special Issue of the Journal of Clinical Medicine , entitled “Recent Advances in Pancreatic Neoplasms”, focuses on new possible strategies to treat pancreatic neoplasms, especially pancreatic adenocarcinoma (PDCA). This Special Issue contains 13 articles, 11 studies and 2 review articles, focusing on the pancreatic ductal adenocarcinoma ( n = 10), intraductal papillary mucinous neoplasm (IPMN) ( n = 1), neuroendocrine tumors ( n = 1) and secondary tumor to the pancreas ( n = 1) [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Seven papers [ 4 , 5 , 6 , 9 , 10 , 11 , 14 ] explored new prognostic factors potentially able to stratify patients with pancreatic cancer and different survival rates in order to select the adequate treatment.…”

“…This Special Issue contains 13 articles, 11 studies and 2 review articles, focusing on the pancreatic ductal adenocarcinoma ( n = 10), intraductal papillary mucinous neoplasm (IPMN) ( n = 1), neuroendocrine tumors ( n = 1) and secondary tumor to the pancreas ( n = 1) [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Seven papers [ 4 , 5 , 6 , 9 , 10 , 11 , 14 ] explored new prognostic factors potentially able to stratify patients with pancreatic cancer and different survival rates in order to select the adequate treatment. Allen et al [ 6 ] examined the relationship between the daily rate of change in CA 19-9 over the first 90 days of chemotherapy for unresectable and metastatic pancreatic cancer and the pretreatment levels of neutrophils, lymphocytes and platelets with an overall progression-free survival.…”

“…In fact, among solid tumors, pancreatic cancer carries the highest prevalence of cancer cachexia and involuntary weight loss [ 18 ]. Pierobon et al [ 14 ] from the University of Padua reviewed the literature and performed a meta-analysis comparing the outcomes of patients, with or without low muscle mass, undergoing pancreatic surgery for PDCA. These authors found that patients with a low muscle mass experienced a reduced OS ( p < 0.001).…”