Impact of body composition on prognostic stratification and survival in periampullary carcinoma after pancreatoduodenectomy.

OBJECTIVES

To evaluate the prognostic impact of preoperative body composition parameters and their changes at three months post-pancreatoduodenectomy (PD) on overall survival (OS) and recurrence-free survival (RFS) in periampullary carcinoma patients.

MATERIALS AND METHODS

This retrospective study analyzed 505 patients (294 males, mean age 62.58 ± 9.66 years; 211 females, 63.16 ± 9.89 years) who underwent PD between January 2018 and August 2022. The mean follow-up period was 37.07 ± 17.67 months, with 128 deaths (25.3%). Preoperative CT metrics included skeletal muscle index (SMI), skeletal muscle radiodensity (SMRA), intramuscular adipose tissue index (IMATI), subcutaneous adipose tissue index (SATI), and visceral adipose tissue index (VATI). Longitudinal changes were analyzed in 356 patients who underwent 3-month follow-up CT scan. Cox regression models were used to assess prognostic factors for OS and RFS.

RESULTS

In males, low SMI and high IMATI were independent predictors of worse OS (HR 2.392, 95% CI, 1.135-5.043, P = 0.022; and HR 3.310, 95% CI, 1.741-6.294, P < 0.001, respectively). In females, low SMRA was the key prognostic factor (HR 2.272, 95% CI, 1.007-5.128, P = 0.048). All parameters significantly decreased after 3 months. Among patients stratified by preoperative SMI, those with high SMI decline (≥ 8.4% loss for males, ≥ 4.5% loss for females) had worse prognoses than those with low decline (P < 0.05).

CONCLUSIONS

Preoperative body composition is associated with OS in patients with periampullary carcinoma. Integrating preoperative SMI status and postoperative SMI changes provide a more nuanced prognostic stratification. Gender-specific body composition analysis may improve prognostic accuracy and postoperative management.