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      Preoperative sarcopenia and post‐operative accelerated muscle loss negatively impact survival after resection of pancreatic cancer

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          Abstract

          Background

          Sarcopenia and post‐operative accelerated muscle loss leading to cachexia are commonly observed in patients with pancreatic cancer. This study aimed to assess the influence of body compositions and post‐operative muscle change on survival of patients with surgically treated pancreatic cancer.

          Methods

          We analysed data of patients diagnosed with pancreatic adenocarcinoma who underwent surgery from 2008 to 2015. Skeletal muscle areas, muscle attenuation, and visceral and subcutaneous adipose tissue areas were measured from two sets of computed tomography images at L3 vertebral levels. In addition, muscle change was calculated from images obtained before and after cancer resection. We set our own cut‐off values of various body compositions based on sex‐specific tertiles.

          Results

          A total of 180 patients were analysed. Patients with perioperative sarcopenia ( n = 60) showed poorer overall survival than those without perioperative sarcopenia ( P = 0.031). Fifty (28.6%) patients with accelerated muscle loss after surgery (>10%/60 days) had poorer survival compared with the others ( P = 0.029). Sarcopenia (hazard ratio, 1.79: 95% confidence interval, 1.20–2.65] and post‐operative muscle change (%/60 days) (hazard ratio, 0.94: 95% confidence interval, 0.92–0.96) were identified as significant predictors of survival on multivariable analyses.

          Conclusions

          Preoperative sarcopenia identified on CT scan was associated with poor overall survival in patients with pancreatic cancer following surgery. Accelerated muscle loss after surgery also negatively impacted survival in pancreatic cancer patients.

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          Most cited references23

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          Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery.

          Kostan W. Reisinger, Jeroen van Vugt, Juul Tegels … (2015)
          To determine the association of sarcopenia with postoperative morbidity and mortality after colorectal surgery.
          Article 0 comments Cited 142 times – based on 0 reviews     Review now
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            Body composition in patients with non-small cell lung cancer: a contemporary view of cancer cachexia with the use of computed tomography image analysis.

            Tony Reiman, S Antoun, Ioannis Gioulbasanis … (2010)
            The prominent clinical feature of cachexia has traditionally been understood to be weight loss; however, in recognition of the potential for divergent behavior of muscle and adipose tissue, cachexia was recently defined as loss of muscle with or without loss of fat mass. Detailed assessments are required to verify body composition in patients with cancer cachexia. We adopted a population-based approach to study body composition in patients with cancer, with the use of diagnostic computed tomography images acquired for cancer diagnosis and follow-up. A prospective cohort of 441 patients with non-small cell lung cancer, who were referred consecutively to a regional medical oncology service in Alberta, Canada, was evaluated. At referral (median time to death: 265 d), mean body mass index (BMI; in kg/m(2)) was 24.9, with 47.4% of patients being overweight or obese. Only 7.5% overall were underweight as conventionally understood (BMI < 18.5). Analysis of computed tomography images showed extremely high heterogeneity of muscle mass within all strata of BMI. The overall prevalence of severe muscle depletion (sarcopenia) was 46.8% and was present in patients in all BMI categories. A much higher proportion of men (61%) than women (31%) met the criteria for sarcopenia. Wasting of skeletal muscle is a prominent feature of patients with lung cancer, despite normal or heavy body weights. The significance of muscle wasting in normal-weight, overweight, and obese patients as a nutritional risk factor, as a prognostic factor, and as a predictor of cancer treatment toxicity is discussed in this article.
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              Survival after resection of pancreatic adenocarcinoma: results from a single institution over three decades.

              Peter J. Allen, Sandra Winter, David Klimstra … (2011)
              Randomized trials have demonstrated a benefit associated with adjuvant therapy for pancreatic cancer, and retrospective studies have demonstrated improvements in postoperative mortality. The purpose of this study was to evaluate whether these improvements could be identified in a cohort of patients who underwent resection for pancreatic cancer at a single institution over three decades. Short- (30 days), intermediate- (1 year), and long-term survival were compared between decades. Long-term survival focused on patients who survived at least 1 year to minimize the effects of perioperative mortality and patient selection. Between 1983 and 2009, 1147 pancreatic resections were performed for ductal adenocarcinoma, including 123 resections in the 1980s, 399 in the 1990s, and 625 in the 2000s. The 30-day mortality rates were 4.9%, 1.5% (P = 0.03 vs. 1980s), and 1.3% (P = 0.007 vs. 1980s). The 1-year mortality rates were 42%, 31% (P < 0.001 vs. 1980s), and 24% (P < 0.001 vs. 1980s and 1990s). In the group of patients who survived 1 year, the overall survivals were 23.2 months, 25.6 months (P = 0.6 vs. 1980s), and 24.5 months (P = 0.2 vs. 1980s). In a multivariate analysis adjusted for pathologic features, the decade of resection was not a significant predictor of long-term survival (hazard ratio = 1.1, P = 0.3). Patients who underwent resection for pancreatic cancer between 2000 and 2009 experienced improved operative mortality and 1-year survival compared to those who underwent resection in the 1980s, while the long-term survival was similar over all three decades. These results underscore the need for early detection strategies and more effective adjuvant therapies for patients with pancreatic cancer.
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                Author and article information

                Contributors
                Seung Bae Yoon: sbyoon@catholic.ac.kr
                Journal
                Journal ID (nlm-ta): J Cachexia Sarcopenia Muscle
                Journal ID (iso-abbrev): J Cachexia Sarcopenia Muscle
                Journal ID (doi): 10.1007/13539.2190-6009
                Journal ID (publisher-id): JCSM
                Title: Journal of Cachexia, Sarcopenia and Muscle
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 2190-5991
                ISSN (Electronic): 2190-6009
                Publication date (Electronic): 05 February 2018
                Publication date (Print): April 2018
                Volume: 9
                Issue: 2 ( doiID: 10.1002/jcsm.v9.2 )
                Pages: 326-334
                Affiliations
                [ 1 ] Cancer Research Institute, College of Medicine The Catholic University of Korea Seoul Korea
                [ 2 ] Department of Radiology, College of Medicine The Catholic University of Korea Seoul Korea
                [ 3 ] Department of Internal Medicine, College of Medicine The Catholic University of Korea Seoul Korea
                [ 4 ] Department of Surgery, College of Medicine The Catholic University of Korea Seoul Korea
                Author notes
                [*] [* ]Correspondence to: Seung Bae Yoon, MD, PhD., Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo‐daero, Seocho‐gu, Seoul 06591, Korea. Email: sbyoon@ 123456catholic.ac.kr
                Article
                Publisher ID: JCSM12274 Other ID: JCSM-D-17-00164
                DOI: 10.1002/jcsm.12274
                PMC ID: 5879976
                PubMed ID: 29399990
                SO-VID: efa967f5-6b61-4cdb-93c2-520fd2b503d2
                Copyright © © 2018 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                Date received : 20 June 2017
                Date accepted : 14 November 2017
                Page count
                Figures: 2, Tables: 6, Pages: 9, Words: 3599
                Funding
                Funded by: National Research Foundation of Korea
                Award ID: NRF‐2015R1C1A1A02037568
                Categories
                Subject: Original Article
                Subject: Original Articles
                Custom metadata
                source-schema-version-number 2.0
                component-id jcsm12274
                cover-date April 2018
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.4 mode:remove_FC converted:02.04.2018

                ScienceOpen disciplines: Orthopedics
                Keywords: sarcopenia,muscle loss,pancreatic cancer,pancreatectomy,survival
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: sarcopenia, muscle loss, pancreatic cancer, pancreatectomy, survival

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