Sarcopenia in pancreatic cancer: Effect on patient outcomes

Table 1 Studies analyzing the effect of sarcopenia on surgical outcomes of pancreatic cancer

Ref.	Country	No. of patients	Imaging modality	Level	Time	Definition and cutoff	Sarcopenia prevalence before surgery	Types of surgery	Perioperative complications	Survival	Additional meaningful findings or comments
Peng et al[24], 2012	United States	557	CT	L3	Before surgery	TPAI (mm2/m2), lowest quartile: < 564.2 (M), < 414.5 (F)	25%	PD, DP	(-)	(+) OS	Sarcopenia was an independent predictor of survival in multivariable analysis
Amini et al[7], 2015	United States	763	CT	L3	Before surgery	TPAI (mm2/m2), < 564.2 (M), 414.5 (F); TPVI (cm³/m2), < 17.2 (M), < 12.0 (F)	25% by TPAI, 20% by TPVI	PD, DP. TP	(+) Overall Cx. by TPVI	(+) OS by TPVI	TPVI was a better measure for defining sarcopenia rather than TPAI
Pecorelli et al[9], 2016	Italy	202	CT	L3	Before surgery	LSMI, < 52.4 cm2/m2 (M), < 38.5 cm2/m2 (F)1	65%	PD	(-)	NE	The combination of visceral obesity and sarcopenia was a predictor of perioperative Cx
Ninomiya et al[28], 2017	Japan	265	CT	L3	Before surgery	LSMI, < 43.75 cm2/m2 (M), < 38.5 cm2/m2 (F)	64%	PD, DP. TP	(-)	(-)	Sarcopenia was an independent prognostic factor only in patients with BMI ≥ 22 kg/m2
Okumura et al[29], 2017	Japan	301	CT	L3	Before surgery	LSMI, clinically relevant cutoff: < 47.1 cm2/m2 (M), < 36.6 cm2/m2 (F)	40%	PD, DP. TP	(-)	(+) OS and RFS	Low muscle attenuation, as well as low muscle mass, was associated with worse OS and RFS
Choi et al[18], 2018	South Korea	180	CT	L3	Before and after 60 d of surgery	LSMI, the lowest tertile; < 45.3 cm2/m2 (M), < 39.3 cm2/m2 (F)	33%	PD, DP	(-)	(+) OS	Accelerated muscle loss after surgery negatively impacts OS
Sugimoto et al[19], 2018	United States	323	CT	L3	Before surgery	LSMI, < 55.4 cm2/m2 (M), < 38.9 cm2/m2 (F)	62%	PD, DP. TP	NE	(-)	Smaller sex-standardized LSMI as a continuous variable is associated with a shorter OS
Gruber et al[10], 2019	Austria	133	CT	L3	Before surgery	LSMI, < 52.4 cm2/m2 (M), < 38.5 cm2/m2 (F)1	59%	PD, DP	(-)	(+) OS	Obese patients (BMI ≥ 25) with sarcopenia have higher incidence of major post-operative Cx
Ryu et al[30], 2020	South Korea	548	CT	L3	Before surgery	LSMI, < 50.18 cm2/m2 (M), < 38.63 cm2/m2 (F)	46%	PD	(-)	(+) OS	Sarcopenic obesity is a predictive factor for post-operative pancreatic fistula after PD
Rom et al[25], 2022	Israel	111	CT	L3	Before surgery	LSMI, the lowest quartile: < 44; 35 cm2/m2 (M), < 34.82 cm2/m2 (F)	25%	PD, DP	(+) Overall Cx.	(+) OS, DSS, and RFS	High intramuscular adipose tissue content correlates with poor OS and DSS

¹This cutoff value for sarcopenia was defined by Prado et al[8] (2008). BMI: Body mass index; CT: Computed tomography; Cx.: Complications; DP: Distal pancreatectomy; DSS: Disease-specific survival; F: Female; L3: Level of the lumbar 3 vertebral body; LSMI: Lumbar skeletal muscle index; M: Male; NE: Not evaluated; OS: Overall survival; PD: Pancreaticoduodenectomy; RFS: Recurrence-free survival; TPAI: Total psoas area index; TPVI: Total psoas volume index; TP: Total pancreatectomy.