Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma.
BACKGROUND
Assessing patient-specific risk factors for long-term mortality following resection of pancreatic adenocarcinoma can be difficult. Sarcopenia--the measurement of muscle wasting--may be a more objective and comprehensive patient-specific factor associated with long-term survival.


METHODS
Total psoas area (TPA) was measured on preoperative cross-sectional imaging in 557 patients undergoing resection of pancreatic adenocarcinoma between 1996 and 2010. Sarcopenia was defined as the presence of a TPA in the lowest sex-specific quartile. The impact of sarcopenia on 90-day, 1-year, and 3-year mortality was assessed relative to other clinicopathological factors.


RESULTS
Mean patient age was 65.7 years and 53.1 % was male. Mean TPA among men (611 mm²/m²) was greater than among women (454 mm²/m²). Surgery involved pancreaticoduodenectomy (86.0 %) or distal pancreatectomy (14.0 %). Mean tumor size was 3.4 cm; 49.9 % and 88.5 % of patients had vascular and perineural invasion, respectively. Margin status was R0 (59.0 %) and 77.7 % patients had lymph node metastasis. Overall 90-day mortality was 3.1 % and overall 1- and 3-year survival was 67.9 % and 35.7 %, respectively. Sarcopenia was associated with increased risk of 3-year mortality (HR = 1.68; P < 0.001). Tumor-specific factors such as poor differentiation on histology (HR = 1.75), margin status (HR = 1.66), and lymph node metastasis (HR = 2.06) were associated with risk of death at 3-years (all P < 0.001). After controlling for these factors, sarcopenia remained independently associated with an increased risk of death at 3 years (HR = 1.63; P < 0.001).


CONCLUSIONS
Sarcopenia was a predictor of survival following pancreatic surgery, with sarcopenic patients having a 63 % increased risk of death at 3 years. Sarcopenia was an objective measure of patient frailty that was strongly associated with long-term outcome independent of tumor-specific factors.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Peter
P
Peng
Omar
O
Hyder
Amin
A
Firoozmand
Peter
P
Kneuertz
Richard D
RD
Schulick
Donghang
D
Huang
Martin
M
Makary
Kenzo
K
Hirose
Barish
B
Edil
Michael A
MA
Choti
Joseph
J
Herman
John L
JL
Cameron
Christopher L
CL
Wolfgang
Timothy M
TM
Pawlik
D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011300:Preoperative Care; D016658:Psoas Muscles / Q000473:pathology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055948:Sarcopenia / Q000150:complications*; D015996:Survival Rate; D016896:Treatment Outcome