Drastic muscle wasting following surgery is a strong predictor of prognosis in early-stage pancreatic cancer-a Taiwanese multicenter cohort study.
Abstract
Objective
To clarify the impact of preoperative sarcopenia and muscle wasting postoperative on the short- and long-term outcomes following pancreatectomy in resectable pancreatic cancer (PC) patients. SUMMARY
Background
DATA Previous studies revealed that sarcopenia, defined as generalized loss of skeletal muscle mass, was a poor prognosis factor following surgery. However, research focus on postoperative muscle wasting and their influences on the prognosis in resectable PC was very limited.
Methods
Retrospective analysis was performed for 284 early-stage PC patients who underwent pancreatic resection in two medical centers. Preoperative psoas major area and the degree of muscle reduction postoperative 3 months were calculated by computed tomography to define sarcopenia and drastic muscle wasting. Patients were assigned to 2 groups based on the presence or absence of sarcopenia or drastic muscle wasting and compared for postoperative morbidity and survival rate.
Results
Sarcopenia was present in 149 of 284 patients (52.4%), and a total of 88 patients (31.0%) developed muscle wasting of over 17% postoperatively. Compared with non-sarcopenia group, patients with sarcopenia had significantly greater incidence of overall or major morbidity (P = 0.001; P = 0.038, respectively), while sarcopenia status didn't correlate with poor-long term survival (DFS, P = 0.812; OS, P = 0.238). Surprisingly, patients presented drastic muscle wasting displayed poor DFS (P < 0.001) and OS (P < 0.001) and were found to be independent predictors of unfavorable DFS (P = 0.005) and OS (P < 0.001) after adjusting for clinicopathologic parameters.
Conclusions
Sarcopenia preoperative is associated with higher risk of morbidity. Moreover, the concept of assessment in wasting muscle quantity following pancreatectomy is essential for accurate long-term prognosis in resectable PC patients.