Cai ZW, Li JL, Liu M, Wang HW, Jiang CY. Low preoperative skeletal muscle index increases the risk of mortality among resectable pancreatic cancer patients: A retrospective study. World J Gastrointest Surg 2022; 14(12): 1350-1362 [PMID: 36632124 DOI: 10.4240/wjgs.v14.i12.1350]
Corresponding Author of This Article
Chong-Yi Jiang, MD, Chief Doctor, Department of General Surgery, Hepato-Biliary-Pancreatic Center, Huadong Hospital, West No. 221 Yan’an Road, Shanghai 200040, China. jiangzhongyi9@sina.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Zhi-Wei Cai, Meng Liu, Hong-Wei Wang, Chong-Yi Jiang, Department of General Surgery, Hepato-Biliary-Pancreatic Center, Huadong Hospital, Shanghai 200040, China
Jia-Lin Li, Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Author contributions: Cai ZW, Li JL, and Liu M contributed equally to this manuscript; Jiang CY participated in the conception and design of this study; Cai ZW participated in the data collection, analysis, and drafting of the article; Li JL and Liu M participated in the design of the study and data analyses; Wang HW participated in the data collection; All authors have read and approved the final manuscript.
Supported byShanghai Science and Technology Commission of Shanghai Municipality, No. 20Y11908600; Shanghai Shenkang Hospital Development Center, No. SHDC2020CR5008; and Shanghai Municipal Health Commission, No. 20194Y0195.
Institutional review board statement: The study was reviewed and approved by the Ethics Review Committee of Huadong Hospital (Shanghai).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chong-Yi Jiang, MD, Chief Doctor, Department of General Surgery, Hepato-Biliary-Pancreatic Center, Huadong Hospital, West No. 221 Yan’an Road, Shanghai 200040, China. jiangzhongyi9@sina.com
Received: September 16, 2022 Peer-review started: September 16, 2022 First decision: October 20, 2022 Revised: October 29, 2022 Accepted: December 6, 2022 Article in press: December 6, 2022 Published online: December 27, 2022 Processing time: 102 Days and 4.9 Hours
Abstract
BACKGROUND
The only potential curative treatment for patients with pancreatic cancer is surgery; however, the prognosis remains poor. Measures of body composition based on computed tomography (CT) have been established as a reliable predictor of the prognosis of cancer patients after surgery.
AIM
To elucidate the associations of body composition measures derived from preoperative CT scans with the prognosis of patients with pancreatic cancer.
METHODS
One hundred fifteen patients undergoing pancreatic resection with curative intent for pancreatic cancer were retrospectively enrolled. A preoperative CT scan at the third lumbar vertebral level was performed to measure the skeletal muscle index (SMI), mean skeletal muscle radiodensity, subcutaneous adipose tissue index, and visceral to subcutaneous adipose tissue area ratio. The clinical and pathological data were collected. The effects of these factors on long-term survival were evaluated.
RESULTS
Among the five body composition measures, only low SMI independently predicted overall survival (OS) [hazard ratio (HR): 2.307; 95% confidence interval (CI): 1.210-4.402] and recurrence-free survival (HR: 1.907; 95%CI: 1.147-3.171). Furthermore, patients with low SMI (vs high SMI) were older (68.8 ± 9.3 years vs 63.3 ± 8.4 years); low SMI was present in 27 of 56 patients (48.2%) aged 65 years and older and in 11 of 59 younger patients (18.6%). In addition, subgroup analyses revealed that the correlation between low SMI and OS was observed only in patients aged 65 years and older.
CONCLUSION
Low preoperative SMI was more prevalent in elderly patients and was associated with a poor prognosis among pancreatic cancer patients, especially elderly patients.
Core Tip: Measures of body composition have been regarded as a reliable prognostic predictor for cancer patients after surgery, but further research is needed. In this study, we showed that low preoperative skeletal muscle index (SMI) potentially predicts the prognosis of pancreatic cancer patients. We also revealed that low SMI was more prevalent in elderly patients and was associated with a poor prognosis among elderly patients after pancreatic cancer resection.
