Rom Hadass, Tamir Shlomit, Van Vugt Jeroen L A, Berger Yael, Perl Gali, Morgenstern Sara, Tovar Ana, Brenner Baruch, Benchimol Daniel, Kashtan Hanoch, Sadot Eran
Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ann Surg Oncol. 2022 Mar;29(3):1553-1563. doi: 10.1245/s10434-021-10995-y. Epub 2021 Oct 30.
To determine whether sarcopenia can potentially predict worse survival after resection of pancreatic ductal adenocarcinoma.
Sarcopenia is correlated with poor outcomes in hepatopancreatobiliary malignancies, but the relationship of both its qualitative and quantitative features with patient survival after pancreatectomy has not been investigated in a western population.
Preoperative cross-sectional computed tomography scans of consecutive patients who underwent pancreatectomy in 2005-2017 were evaluated for skeletal muscle index (SMI), intramuscular adipose tissue content (IMAC), and visceral-to-subcutaneous adipose tissue area ratio (VSR). Sex-specific categorical cut-offs were determined. Findings were correlated with outcome.
The study included 111 patients, 47% of whom were female, with a median age of 67 years (range: 35-87 years), and median body mass index of 23 kg/m (range: 16-40 kg/m); 77% had a Whipple procedure and 66% received adjuvant chemotherapy. Low SMI correlated with poor overall survival (OS) (P = 0.007), disease-specific survival (DSS) (P = 0.006), and recurrence-free survival (RFS) (P = 0.01). High IMAC correlated with poor OS (P = 0.04). Patients with high IMAC tended to have a shorter DSS (P = 0.09), with no correlation with RFS (P = 0.6). VSR was not associated with survival. Multivariable analysis yielded an independent association of low SMI with OS (HR = 1.7, 95%CI: 1.1-2.8, P = 0.02), DSS (HR = 1.8, 95%CI: 1.03-3.2, P = 0.04), and RFS (HR = 1.8, 95%CI: 1.1-2.8, P = 0.01), and of high IMAC with OS (HR = 1.9, 95%CI: 1.1-3.1, P = 0.01).
Both qualitative and quantitative measures of skeletal muscle were independently associated with impaired survival in patients with resectable PDAC. Sarcopenia might serve as an early radiographic surrogate of aggressive tumor behavior, with potential implications for clinical decision-making and future study.
确定肌肉减少症是否有可能预测胰腺导管腺癌切除术后较差的生存率。
肌肉减少症与肝胰胆恶性肿瘤的不良预后相关，但在西方人群中，其定性和定量特征与胰腺切除术后患者生存率的关系尚未得到研究。
对2005年至2017年接受胰腺切除术的连续患者的术前横断面计算机断层扫描进行评估，以测量骨骼肌指数（SMI）、肌内脂肪组织含量（IMAC）和内脏与皮下脂肪组织面积比（VSR）。确定了按性别分类的临界值。研究结果与预后相关。
该研究纳入了111例患者，其中47%为女性，中位年龄为67岁（范围：35 - 87岁），中位体重指数为23kg/m²（范围：16 - 40kg/m²）；77%接受了胰十二指肠切除术，66%接受了辅助化疗。低SMI与总体生存率（OS）较差相关（P = 0.007）、疾病特异性生存率（DSS）较差相关（P = 0.006）以及无复发生存率（RFS）较差相关（P = 0.01）。高IMAC与OS较差相关（P = 0.04）。IMAC高的患者DSS往往较短（P = 0.09），与RFS无相关性（P = 0.6）。VSR与生存率无关。多变量分析显示，低SMI与OS（HR = 1.7，95%CI：1.1 - 2.8，P = 0.02）、DSS（HR = 1.8，95%CI：1.03 - 3.2，P = 0.04）和RFS（HR = 1.8，95%CI：1.1 - 2.8，P = 0.01）独立相关，高IMAC与OS（HR = 1.9，95%CI：1.1 - 3.1，P = 0.01）独立相关。
骨骼肌的定性和定量测量均与可切除性胰腺导管腺癌患者的生存受损独立相关。肌肉减少症可能是侵袭性肿瘤行为的早期影像学替代指标，对临床决策和未来研究具有潜在意义。
