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, 14 (5), e0215915
eCollection

Sarcopenia and Sarcopenic Obesity Are Independent Adverse Prognostic Factors in Resectable Pancreatic Ductal Adenocarcinoma

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Sarcopenia and Sarcopenic Obesity Are Independent Adverse Prognostic Factors in Resectable Pancreatic Ductal Adenocarcinoma

Elisabeth S Gruber et al. PLoS One.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Determination of body composition in patients with resectable pancreatic ductal adenocarcinoma.
Axial contrast-enhanced portal-venous phase CT image at the L3 level of a sarcopenic obese patient (A, 67-year old female, BMI 33 kg/m2, total muscle tissue cross-sectional area 109.2 cm2, skeletal muscle index 39.3 cm2/m2) compared to a non-sarcopenic obese patient (B, 71-year old female, BMI 31 kg/m2, total muscle tissue cross-sectional area 130.4 cm2, skeletal muscle index 47.7 cm2/m2). Marked red: psoas, paraspinal, transverse abdominal, external oblique, internal oblique and rectus abdominis muscles.
Fig 2
Fig 2. Kaplan Meier curve for overall survival in sarcopenic vs. non-sarcopenic patients.
Sarcopenia diminishes overall survival in patients with resectable PDAC (14 vs. 20 months, p = 0.016).
Fig 3
Fig 3. Kaplan Meier curve for overall survival in sarcopenic vs. non-sarcopenic male patients.
Sarcopenia diminishes overall survival in male patients with resectable PDAC (15 vs. 25 months, p = 0.023).
Fig 4
Fig 4. Kaplan Meier curve for overall survival in sarcopenic vs. non-sarcopenic female patients.
Sarcopenia does not diminish overall survival in female patients with resectable PDAC (14 vs. 20 months, p = 0.378).
Fig 5
Fig 5. Kaplan Meier curve for overall survival in obese sarcopenic vs. non-sarcopenic patients (BMI ≥25 kg/m2).
Sarcopenia diminishes overall survival in obese patients with resectable PDAC (14 vs. 23 months, p = 0.007).
Fig 6
Fig 6. Kaplan Meier curve for overall survival in normal/underweight sarcopenic vs. non-sarcopenic patients (BMI <25 kg/m2).
Sarcopenia does not diminish overall survival in normal/underweight patients with resectable PDAC (14 vs. 16 months, p = 0.679).

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The authors received no specific funding for this work.
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