Division of General Surgery, Department of Surgery, Pancreatic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
PLoS One. 2019 May 6;14(5):e0215915. doi: 10.1371/journal.pone.0215915. eCollection 2019.
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.
胰腺导管腺癌（PDAC）的发病率和死亡率正在上升。肌肉减少症和肌少性肥胖已被证明是不同类型癌症的预后因素。基于先前的研究结果，我们评估了在全国胰腺中心接受手术的患者的身体成分对其产生的影响。
对患者的身体成分（n = 133）进行了诊断 CT 扫描分析，并将其定义为：女性骨骼肌指数≤38.5cm2/m2，男性≤52.4cm2/m2；肥胖定义为 BMI≥25kg/m2。
肌肉减少症对总生存期（OS；14 个月 vs. 20 个月，p = 0.016）有负面影响。患有肥胖症的肌少症患者的 OS 比非肌少症肥胖患者更差（14 个月 vs. 23 个月，p = 0.007）。肌肉减少症和肌少性肥胖均与性别相关（p<0.001 和 p = 0.006；男性分别为 20%和 38%，女性分别为 12%和 38%）；肌肉减少症还与新辅助治疗（p = 0.025）、肿瘤分级（p = 0.023）、体重减轻（p = 0.02）和营养耗竭（白蛋白，p = 0.011）以及低 BMI（<25 kg/m2，p = 0.038）相关。肌少性肥胖患者的主要术后并发症发生率较高（p<0.001）。此外，肌肉减少症在多变量 Cox 回归模型中被证明是 OS 的独立预后因素（p = 0.031）。
接受 PDAC 切除术的肌肉减少症和肌少性肥胖症患者的总生存期明显缩短，并发症发生率更高。对这些患者的身体成分进行评估可以更全面地了解患者的个体状况，并为有风险的患者提供特定的支持策略。
