Date Published: May 6, 2019
Publisher: Public Library of Science
Author(s): Elisabeth S. Gruber, Gerd Jomrich, Dietmar Tamandl, Michael Gnant, Martin Schindl, Klaus Sahora, Francisco X. Real.
Incidence and mortality of pancreatic ductal adenocarcinoma (PDAC) are on the rise. Sarcopenia and sarcopenic obesity have proven to be prognostic factors in different types of cancers. In the context of previous findings, we evaluated the impact of body composition in patients undergoing surgery in a national pancreatic center.
Patient’s body composition (n = 133) was analyzed on diagnostic CT scans and defined as follows: Skeletal muscle index ≤38.5 cm2/m2 (women), ≤52.4 cm2/m2 (men); obesity was classified as BMI ≥25kg/m2.
Sarcopenia showed a negative impact on overall survival (OS; 14 vs. 20 months, p = 0.016). Sarcopenic patients suffering from obesity showed poorer OS compared to non-sarcopenic obese patients (14 vs. 23 months, p = 0.007). Both sarcopenia and sarcopenic obesity were associated with sex (p<0.001 and p = 0.006; males vs. females 20% vs. 38% and 12% vs. 38%, respectively); sarcopenia was further associated with neoadjuvant treatment (p = 0.025), tumor grade (p = 0.023), weight loss (p = 0.02) and nutritional depletion (albumin, p = 0.011) as well as low BMI (<25 kg/m2, p = 0.038). Sarcopenic obese patients showed higher incidence of major postoperative complications (p<0.001). In addition, sarcopenia proved as an independent prognostic factor for OS (p = 0.031) in the multivariable Cox Regression model. Patients with sarcopenia and sarcopenic obesity undergoing resection for PDAC have a significantly shorter overall survival and a higher complication rate. The assessment of body composition in these patients may provide a broader understanding of patients’ individual condition and guide specific supportive strategies in patients at risk.
Pancreatic cancer is one of the most lethal malignancies. Even in times of multimodal treatment the prognosis remains poor. In search of prognostic factors, the main focus lies on tumor-specific factors (TNM/UICC) rather than taking host-specific conditions into account. Recently, body composition was evaluated in different oncologic patient cohorts; hereby, sarcopenia proved as a prognostic factor of morbidity, mortality and survival, especially in combination with obesity. It has also been associated with impaired response to chemo- and radiotherapy in a variety of cancers[3–6]. These insights started intensive research on therapeutic strategies including nutritional and pharmacological support as well as physical exercise[7–10]. Guidelines were elaborated to assess sex-specific body composition by measuring the cross-sectional muscle and visceral fat area at the level of the third lumbar vertebra on routinely available diagnostic computed tomography images and to analyze data using validated software[11–15]. Yet, in patients with pancreatic ductal adenocarcinoma (PDAC), data was controversially discussed[16–26]. However, a recent meta-analysis showed that sarcopenia and sarcopenic obesity was significantly associated with poorer overall survival; in patients with resectable PDAC, data on the impact of body composition on treatment-relevant postoperative complications are still rare, thus no conclusion could be drawn from these studies.
Surgery is considered to be the mainstay of curative treatment for patients with PDAC. However, despite multimodal treatment strategies survival remains poor. Yet, approved markers for predicting survival in PDAC are limited to tumor-specific features without considering host-specific body composition as significant determinant of outcome[2, 36–38]. In the present study, we aimed to validate sarcopenia and sarcopenic obesity as prognostic factors in a series of 133 patients undergoing surgery for PDAC in a national pancreatic centre. Our findings confirmed a negative impact of sarcopenia as well as sarcopenic obesity on overall survival (OS).