Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2022; 14(12): 2302-2312
Published online Dec 15, 2022. doi: 10.4251/wjgo.v14.i12.2302
Sarcopenia in pancreatic cancer: Effect on patient outcomes
Moon Hyung Choi, Seung Bae Yoon
Moon Hyung Choi, Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, South Korea
Seung Bae Yoon, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 03312, South Korea
Author contributions: Choi MH and Yoon SB contributed equally to the conception, design, and literature search; Choi MH drafted the manuscript and prepared the tables; Yoon SB modified and revised the manuscript.
Supported by the National Research Foundation of Korea, No. NRF-2021 R1F1A1062255.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Seung Bae Yoon, MD, PhD, Associate Professor, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 1021, Tongil Ro, Eunpyeong-gu, Seoul 03312, South Korea.
Received: September 17, 2022
Peer-review started: September 17, 2022
First decision: October 19, 2022
Revised: October 29, 2022
Accepted: November 28, 2022
Article in press: November 28, 2022
Published online: December 15, 2022

Pancreatic cancer is a challenging disease with an increasing incidence and extremely poor prognosis. The clinical outcomes of pancreatic cancer depend on tumor biology, responses to treatments, and malnutrition or cachexia. Sarcopenia represents a severe catabolic condition defined by the age-related loss of muscle mass and strength and affects as much as 70% of malnourished pancreatic cancer patients. The lumbar skeletal muscle index, defined as the total abdominal muscle area at the L3 vertebral level adjusted by the square of the height, is widely used for assessing sarcopenia in patients with pancreatic cancer. Several studies have suggested that sarcopenia may be a risk factor for perioperative complications and decreased recurrence-free or overall survival in patients with pancreatic cancer undergoing surgery. Sarcopenia could also intensify chemotherapy-induced toxicities and worsen the quality of life and survival in the neoadjuvant or palliative chemotherapy setting. Sarcopenia, not only at the time of diagnosis but also during treatment, decreases survival in patients with pancreatic cancer. Theoretically, multimodal interventions may improve sarcopenia and clinical outcomes; however, no study has reported positive results. Further prospective studies are needed to confirm the prognostic role of sarcopenia and the effects of multimodal interventions in patients with pancreatic cancer.

Keywords: Sarcopenia, Pancreatic cancer, Skeletal muscle, Computed tomography, Outcomes, Survival

Core Tip: Despite advances in diagnosing and treating pancreatic cancer, the prognosis remains poor. More than half of patients with pancreatic cancer develop cachexia and sarcopenia, resulting in poor adherence to intensive treatments. Here, we introduced computed tomography-based body composition analysis, which has been used for analyzing sarcopenia in cancer patients, and covered controversial issues regarding the lack of consensus and diagnostic cutoff points. Recent studies analyzed the effect of sarcopenia on pancreatic cancer on surgery, neoadjuvant therapy, and palliative chemotherapy. Finally, we suggested recommendations for multimodal interventions for the management of sarcopenia and the design of future studies.