Sarcopenia as a prognostic factor in patients with recurrent pancreatic cancer: a retrospective study
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(2020) 18:221
RESEARCH
Open Access
Sarcopenia as a prognostic factor in patients with recurrent pancreatic cancer: a retrospective study Teruhisa Sakamoto*, Takuki Yagyu, Ei Uchinaka, Kozo Miyatani, Takehiko Hanaki, Kyoichi Kihara, Tomoyuki Matsunaga, Manabu Yamamoto, Naruo Tokuyasu, Soichiro Honjo and Yoshiyuki Fujiwara
Abstract Background: Sarcopenia is a prognostic factor in various cancers. However, the impact of sarcopenia in patients with recurrent pancreatic cancer remains unclear. This study evaluated the prognostic significance of sarcopenia in patients with recurrent pancreatic cancer. Methods: Seventy-four patients who developed postoperative recurrence of pancreatic cancer after undergoing pancreatectomies were enrolled. Sarcopenia in these patients was defined according to the psoas muscle index (PMI) measured via computed tomography at the third vertebra. Results: The mean PMIs at the time of recurrence were 4.47 ± 1.27 cm2/m2 for men and 3.26 ± 0.70 cm2/m2 for women. Of the 74 patients, 65 (87.8%) were diagnosed with sarcopenia with low PMI. The 2-year post-recurrence survival curve in the sarcopenia group was significantly worse than that in the non-sarcopenia group (P = 0.034). Multivariate analysis revealed that sarcopenia at the time of recurrence was an independent prognostic factor (P = 0.043) along with a high neutrophil-to-lymphocyte ratio (P = 0.004), early recurrence (P = 0.001), and chemotherapy after recurrence (P = 0.005) in patients with recurrent pancreatic cancer. Furthermore, the area under the curve (AUC) of the combination of sarcopenia and time to recurrence for predicting 2-year survival was 0.763, which was much higher than that of sarcopenia alone (AUC = 0.622). Conclusions: Sarcopenia is a useful prognostic factor in patients with recurrent pancreatic cancer. The combination of sarcopenia and time of recurrence may more accurately predict post-recurrence survival than can sarcopenia alone. Keywords: Recurrent pancreatic cancer, Sarcopenia, Prognosis
Introduction Prognosis in cancer patients is multifactorial. Tumorspecific factors and individual patient characteristics are risk factors for prognosis in patients with various malignant diseases. Many studies have reported that evaluating the body composition can help determine survival outcomes in cancer patients [1–4]. * Correspondence: [email protected] Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago 683-8504, Japan
In 1989, Rosenberg first described sarcopenia as an age-related decrease in skeletal muscle mass [5]. Sarcopenia was later defined as a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with adverse outcomes, including physical disability, poor quality of life, and death. Sarcopenia was further classified into primary sarcopenia, caused only by aging, and secondary sarcopenia, with causes such as physical hypoactivity, malnutrition, inflammatory dis
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