Katie E Rollins1, Nilanjana Tewari1, Abigail Ackner1, Amir Awwad2, Srinivasan Madhusudan3, Ian A Macdonald4, Kenneth C H Fearon5, Dileep N Lobo6. 1. Gastrointestinal Surgery, National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK. 2. Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham University Hospitals, Queen's Medical Centre, Nottingham NG7 2UH, UK. 3. Academic Oncology, University of Nottingham, School of Medicine, Nottingham University Hospitals, City Hospital Campus, Nottingham NG5 1PB, UK. 4. Metabolic Physiology Group, School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK. 5. Department of Clinical and Surgical Sciences, University of Edinburgh, Royal Infirmary, Edinburgh EH16 4SA, UK. 6. Gastrointestinal Surgery, National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK. Electronic address: Dileep.Lobo@nottingham.ac.uk.
Abstract
BACKGROUND & AIMS: Patients with pancreatic cancer have a poor prognosis, are often cachectic, and frequently demonstrate features of systemic inflammation, which may contribute to the phenomenon of myosteatosis. Analysis of body composition from CT scans has been used to study sarcopenia and its association with prognosis in a number of types of cancer, particular in combination with obesity. It has also been suggested that myosteatosis, defined as attenuated mean skeletal muscle Hounsfield units (HU), is associated with reduced survival in cancer. This study aimed to assess the association between body composition (sarcopenia and myosteatosis) and outcome in patients with unresectable pancreatic cancer. METHODS: All patients diagnosed with unresectable pancreatic cancer at Nottingham University Hospitals NHS Trust between 2006 and 2013 were considered for the study. A total of 228 patients were included retrospectively. Body composition was assessed using cross-sectional CT analysis to calculate a skeletal muscle index (SMI) for sarcopenia and use mean skeletal muscle HU for myosteatosis. RESULTS: The prevalence of sarcopenia in the whole patient group at baseline was 60.5% (138/228). Overall, patients who were sarcopenic had no significant difference in overall survival versus those who were not (p = 0.779). However, patients who were overweight/obese and sarcopenic had a significantly lower survival (p = 0.013). Of the 58 patients who were overweight or obese and sarcopenic, 32 were also myosteatotic. The prevalence of myosteatosis overall at baseline was 55.3% (126/228) and this was associated with significant reduction in overall survival (p = 0.049). Univariate Cox regression revealed myosteatosis but not sarcopenia to be predictive of reduced survival, however this relationship was lost on multivariate testing. Myosteatosis was associated with significantly greater levels of systemic inflammation (white cell count, neutrophil-lymphocyte ratio and C-reactive protein), anaemia and worsening of baseline blood urea. This relationship was not seen with sarcopenia. CONCLUSIONS: This is the largest study on the association between body composition and survival in patients with unresectable pancreatic cancer and has shown that although sarcopenia alone did not have a bearing on survival, the presence of myosteatosis was associated significantly with the presence of systemic inflammation and reduced survival.
BACKGROUND & AIMS:Patients with pancreatic cancer have a poor prognosis, are often cachectic, and frequently demonstrate features of systemic inflammation, which may contribute to the phenomenon of myosteatosis. Analysis of body composition from CT scans has been used to study sarcopenia and its association with prognosis in a number of types of cancer, particular in combination with obesity. It has also been suggested that myosteatosis, defined as attenuated mean skeletal muscle Hounsfield units (HU), is associated with reduced survival in cancer. This study aimed to assess the association between body composition (sarcopenia and myosteatosis) and outcome in patients with unresectable pancreatic cancer. METHODS: All patients diagnosed with unresectable pancreatic cancer at Nottingham University Hospitals NHS Trust between 2006 and 2013 were considered for the study. A total of 228 patients were included retrospectively. Body composition was assessed using cross-sectional CT analysis to calculate a skeletal muscle index (SMI) for sarcopenia and use mean skeletal muscle HU for myosteatosis. RESULTS: The prevalence of sarcopenia in the whole patient group at baseline was 60.5% (138/228). Overall, patients who were sarcopenic had no significant difference in overall survival versus those who were not (p = 0.779). However, patients who were overweight/obese and sarcopenic had a significantly lower survival (p = 0.013). Of the 58 patients who were overweight or obese and sarcopenic, 32 were also myosteatotic. The prevalence of myosteatosis overall at baseline was 55.3% (126/228) and this was associated with significant reduction in overall survival (p = 0.049). Univariate Cox regression revealed myosteatosis but not sarcopenia to be predictive of reduced survival, however this relationship was lost on multivariate testing. Myosteatosis was associated with significantly greater levels of systemic inflammation (white cell count, neutrophil-lymphocyte ratio and C-reactive protein), anaemia and worsening of baseline blood urea. This relationship was not seen with sarcopenia. CONCLUSIONS: This is the largest study on the association between body composition and survival in patients with unresectable pancreatic cancer and has shown that although sarcopenia alone did not have a bearing on survival, the presence of myosteatosis was associated significantly with the presence of systemic inflammation and reduced survival.
Authors: Ana Babic; Michael H Rosenthal; Gloria M Petersen; Brian M Wolpin; William R Bamlet; Naoki Takahashi; Motokazu Sugimoto; Laura V Danai; Vicente Morales-Oyarvide; Natalia Khalaf; Richard F Dunne; Lauren K Brais; Marisa W Welch; Caitlin L Zellers; Courtney Dennis; Nader Rifai; Carla M Prado; Bette Caan; Tilak K Sundaresan; Jeffrey A Meyerhardt; Matthew H Kulke; Clary B Clish; Kimmie Ng; Matthew G Vander Heiden Journal: Cancer Epidemiol Biomarkers Prev Date: 2019-09-18 Impact factor: 4.254
Authors: Jingjie Xiao; Bette J Caan; Elizabeth M Cespedes Feliciano; Jeffrey A Meyerhardt; Candyce H Kroenke; Vickie E Baracos; Erin Weltzien; Marilyn L Kwan; Stacey E Alexeeff; Adrienne L Castillo; Carla M Prado Journal: Am J Clin Nutr Date: 2019-03-01 Impact factor: 7.045
Authors: Marta Sandini; Manuel Patino; Cristina R Ferrone; Carlos A Alvarez-Pérez; Kim C Honselmann; Salvatore Paiella; Matteo Catania; Luca Riva; Giorgia Tedesco; Raffaella Casolino; Alessandra Auriemma; Maria C Salandini; Giulia Carrara; Giulia Cristel; Anna Damascelli; Davide Ippolito; Mirko D'Onofrio; Keith D Lillemoe; Claudio Bassi; Marco Braga; Luca Gianotti; Dushyant Sahani; Carlos Fernández-Del Castillo Journal: JAMA Surg Date: 2018-09-01 Impact factor: 14.766
Authors: Motokazu Sugimoto; Michael B Farnell; David M Nagorney; Michael L Kendrick; Mark J Truty; Rory L Smoot; Suresh T Chari; Michael R Moynagh; Gloria M Petersen; Rickey E Carter; Naoki Takahashi Journal: J Gastrointest Surg Date: 2018-02-01 Impact factor: 3.452
Authors: Ammar Sukari; Irfana Muqbil; Ramzi M Mohammad; Philip A Philip; Asfar S Azmi Journal: Semin Cancer Biol Date: 2016-01-21 Impact factor: 15.707