1
|
Bareiß S, Merkel S, Krautz C, Weber GF, Grützmann R, Brunner M. Prognostic role of nutrition parameters on short- and long-term outcome in patients with primary resectable pancreatic ductal adenocarcinoma. Clin Nutr ESPEN 2024; 62:296-302. [PMID: 38878292 DOI: 10.1016/j.clnesp.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/16/2024] [Accepted: 06/02/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE Nutrition status of patients with pancreatic ductal adenocarcinoma (PDAC) has gained an increasing importance - especially in the preoperative setting. The aim of the present study was to evaluate different preoperative nutritional parameters including body composition parameters regarding their impact on short- and long-term outcome in patients with resectable PDAC. METHODS This retrospective single center study included 162 patients, who underwent primary resection of PDAC from January 2003 to December 2018 at the University Hospital of Erlangen. The influence of different preoperative nutrition parameters as well as different CT-based body composition parameters on short- (major morbidity, postoperative pancreatic fistula (POPF) and longer hospital stay) as well as on long-term outcome (overall and disease-free survival) were tested using multiple regression analysis. RESULTS Major morbidity and POPF occurred in 30% respectively 18%. Median length of hospital stay was 18 days. Median overall and disease free survival were 20.3 respectively 12.0 months. Multivariate analysis revealed among the different nutritional parameters following independent predictors: PMTH (psoas muscle thickness/height) for major morbidity (HR 2.1, p = 0.038), PMA (psoas muscle area) for a prolonged hospital stay >18 days (HR 7.3, p = 0.010) and NRS (nutritional risk score) for overall survival (HR 1.7, p = 0.043). CONCLUSION In our cohort, nutritional parameters played a minor role in predicting short- and long-term outcome in patients with primary resectable PDAC, as there were only significant associations between selected psoas muscle parameters and short-term outcome parameters and the nutritional risk score (NRS) with the overall survival.
Collapse
Affiliation(s)
- Sophie Bareiß
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Susanne Merkel
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Christian Krautz
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Georg F Weber
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Robert Grützmann
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Maximilian Brunner
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany.
| |
Collapse
|
2
|
Pecchi A, Valoriani F, Cuoghi Costantini R, Squecco D, Spallanzani A, D’Amico R, Dominici M, Di Benedetto F, Torricelli P, Menozzi R. Role of Body Composition in Patients with Resectable Pancreatic Cancer. Nutrients 2024; 16:1834. [PMID: 38931189 PMCID: PMC11206463 DOI: 10.3390/nu16121834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/28/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
This study investigates the role of body composition parameters in patients with pancreatic cancer undergoing surgical treatment. The research involved 88 patients diagnosed with pancreatic cancer who underwent surgery at the Modena Cancer Center between June 2015 and October 2023. Body composition parameters were obtained from CT scans performed before and after surgery. The percentage of sarcopenic patients at the time of diagnosis of pancreatic cancer is 56.82%. Of the patients who died between the first and second CT evaluated, 58% were sarcopenic, thus confirming the role of sarcopenia on outcome. The study found that all body composition parameters (TAMA, SMI, VFI, and SFI) demonstrated a trend towards reduction between two examinations, indicating an overall depletion in muscle and adipose tissue. We then evaluated the relationships between fat-related parameters (VFI, SFI and VSR) and survival outcomes: overall survival and progression-free survival. Cox univariate regression model show significant parameter related to outcomes was adipose tissue, specifically VFI. The study found that higher VFI levels were associated with greater survival rates. This research holds promise for advancing our understanding of the link between body composition and the prognosis of pancreatic cancer patients.
Collapse
Affiliation(s)
- Annarita Pecchi
- Radiology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (D.S.); (P.T.)
| | - Filippo Valoriani
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, Modena University Hospital, 41124 Modena, Italy; (F.V.); (R.M.)
| | | | - Denise Squecco
- Radiology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (D.S.); (P.T.)
| | - Andrea Spallanzani
- Oncology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.S.); (M.D.)
| | - Roberto D’Amico
- Unit of Clinical Statistics, University Hospital of Modena, 41124 Modena, Italy; (R.C.C.); (R.D.)
| | - Massimo Dominici
- Oncology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.S.); (M.D.)
| | - Fabrizio Di Benedetto
- Hepato-Bilio-Pancreatic Surgery and Liver Transplantation Unit, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Pietro Torricelli
- Radiology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (D.S.); (P.T.)
| | - Renata Menozzi
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, Modena University Hospital, 41124 Modena, Italy; (F.V.); (R.M.)
| |
Collapse
|
3
|
Mita J, Maeda T, Tsujita E, Hashimoto N, Fujikawa R, Ono Y, Sakai A, Tanaka S, Matono R, Ohmine T, Kometani T, Yamaguchi S, Konishi K, Hashimoto K. Skeletal Muscle Mass Index Reduction Rate as a Prognostic Indicator for Patients Undergoing Pancreatectomy for Pancreatic Cancer. CANCER DIAGNOSIS & PROGNOSIS 2024; 4:301-308. [PMID: 38707741 PMCID: PMC11062158 DOI: 10.21873/cdp.10324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 02/22/2024] [Indexed: 05/07/2024]
Abstract
Background/Aim There have been many studies on skeletal muscle depletion before surgery, and skeletal muscle depletion is a known risk factor for poor prognosis. However, reports on the association between changes in skeletal muscle mass and prognosis after surgery for pancreatic cancer are very few. Patients and Methods The data of 137 patients who underwent pancreatectomy for pancreatic cancer between 2005 and 2022 were reviewed. Muscle areas were measured at the third lumbar vertebral level, and skeletal muscle mass index (SMI) reduction rates were calculated. Patients were divided into two groups using receiver operating characteristic (ROC) curve analysis based on the SMI reduction rate with a cutoff of 14% reduction rate. The clinicopathological factors, overall survival (OS), and recurrence-free survival (RFS) were compared between the two groups. Survival rates were analyzed both univariately and multivariately to clarify the factors associated with poor prognosis after pancreatectomy. Results A total of 102 patients met the inclusion criteria. SMI reduction rate ≥14% significantly correlated with advanced age and higher incidence of postoperative complications. In the multivariate Cox regression analysis, preoperative prognostic nutritional index (PNI) <40 and SMI reduction rate ≥14% were significantly associated with poor OS. Tumor size ≥3.0 cm, preoperative neutrophile-lymphocyte ratio ≥3.0, and SMI reduction rate ≥14% were significantly associated with poor RFS. Conclusion The rate of skeletal muscle mass reduction after pancreatic surgery is an independent prognostic factor for survival in patients with pancreatic cancer.
Collapse
Affiliation(s)
- Junya Mita
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Takashi Maeda
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Eiji Tsujita
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Naotaka Hashimoto
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Ranma Fujikawa
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Yuki Ono
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Akihiro Sakai
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Shinichi Tanaka
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Rumi Matono
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Takahiro Ohmine
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Takuro Kometani
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Shohei Yamaguchi
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Kozo Konishi
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Kenkichi Hashimoto
- Department of Surgery, Hiroshima Red Cross & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| |
Collapse
|
4
|
Liu C, An L, Zhang S, Deng S, Wang N, Tang H. Association between preoperative sarcopenia and prognosis of pancreatic cancer after curative-intent surgery: a updated systematic review and meta-analysis. World J Surg Oncol 2024; 22:38. [PMID: 38287345 PMCID: PMC10825983 DOI: 10.1186/s12957-024-03310-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/13/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Sarcopenia is associated with poor outcomes in many malignancies. However, the relationship between sarcopenia and the prognosis of pancreatic cancer has not been well understood. The aim of this meta-analysis was to identify the prognostic value of preoperative sarcopenia in patients with pancreatic cancer after curative-intent surgery. METHODS Database from PubMed, Embase, and Web of Science were searched from its inception to July 2023. The primary outcomes were overall survival (OS), progression-free survival (PFS), and the incidence of major complications. The hazard ratio (HR), odds ratio (OR), and 95% confidence intervals (CIs) were used to assess the relationship between preoperative sarcopenia and the prognosis of patients with pancreatic cancer. All statistical analyses were conducted by Review Manager 5.3 and STATA 17.0 software. RESULTS A total of 23 retrospective studies involving 5888 patients were included in this meta-analysis. The pooled results demonstrated that sarcopenia was significantly associated with worse OS (HR = 1.53, P < 0.00001) and PFS (HR = 1.55, P < 0.00001). However, this association was not obvious in regard to the incidence of major complications (OR = 1.33, P = 0.11). CONCLUSION Preoperative sarcopenia was preliminarily proved to be associated with the terrible prognosis of pancreatic cancer after surgery. However, this relationship needs to be further validated in more prospective studies.
Collapse
Affiliation(s)
- Chenming Liu
- Department of Hepatopancreatobiliary Surgery, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Liang An
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Siyuan Zhang
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Shiqing Deng
- Department of Breast and Thyroid Surgery, General Hospital of Huainan Eastern Hospital Group, Huainan, Anhui, China
| | - Neng Wang
- Department of Hepatopancreatobiliary Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, China
| | - Haijun Tang
- Department of Hepatopancreatobiliary Surgery, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
| |
Collapse
|