Daniel Delitto1, Sarah M Judge2, Thomas J George3, George A Sarosi4, Ryan M Thomas4, Kevin E Behrns1, Steven J Hughes1, Andrew R Judge2, Jose G Trevino5. 1. Department of Surgery, College of Medicine, University of Florida Health Science Center, Gainesville, FL. 2. Department of Physical Therapy, University of Florida Health Science Center, Gainesville, FL. 3. Department of Medicine, College of Medicine, University of Florida Health Science Center, Gainesville, FL. 4. Department of Surgery, College of Medicine, University of Florida Health Science Center, Gainesville, FL; North Florida/South Georgia Veterans Health System, Department of Surgery, University of Florida College of Medicine, Gainesville, FL. 5. Department of Surgery, College of Medicine, University of Florida Health Science Center, Gainesville, FL. Electronic address: jose.trevino@surgery.ufl.edu.
Abstract
BACKGROUND: The relationship between myopenia, nutritional status, and long-term oncologic outcomes remains poorly characterized in patients with clinically resectable pancreatic cancer. We sought to reliably quantify prognostic indicators of preoperative cachexia in a manner applicable to any clinical setting. METHODS: Preoperative computed tomographies were available electronically and suitable for analysis in 73 of 82 consecutive patients with pancreatic cancer undergoing pancreatoduodenectomy between November 2010 and February 2014. The psoas index was computed from the cross-sectional area of the psoas muscles normalized to vertebral body area at the third lumbar vertebra. Correlation and proportional hazards analyses were performed to identify relationships between muscularity, preoperative nutritional markers, clinicopathologic parameters, and long-term survival. RESULTS: The psoas index correlated strongly with preoperative hemoglobin and albumin levels (P = .001 and .014, respectively) identifying a pattern of preoperative frailty. High psoas index and the albumin and hemoglobin levels were associated with improved long-term survival (hazard ratio 0.014, P < .001; hazard ratio 0.43, P < .001; and hazard ratio = 0.80, P = .014); however, on multivariate analysis, the psoas index proved to be the only independent predictor of survival (hazard ratio 0.021; P = .003). Rapid decreases in the psoas index during neoadjuvant chemotherapy were associated with poor postoperative outcomes, as were decreases in the psoas index during the postoperative period. CONCLUSION: The data indicate that the psoas index, a calculation derived from a clinically mandated, preoperative computed tomography, is a statistically powerful and easily calculated predictor of survival in pancreatic cancer when compared to tumor grade and stage as well as previously validated nutritional parameters.
BACKGROUND: The relationship between myopenia, nutritional status, and long-term oncologic outcomes remains poorly characterized in patients with clinically resectable pancreatic cancer. We sought to reliably quantify prognostic indicators of preoperative cachexia in a manner applicable to any clinical setting. METHODS: Preoperative computed tomographies were available electronically and suitable for analysis in 73 of 82 consecutive patients with pancreatic cancer undergoing pancreatoduodenectomy between November 2010 and February 2014. The psoas index was computed from the cross-sectional area of the psoas muscles normalized to vertebral body area at the third lumbar vertebra. Correlation and proportional hazards analyses were performed to identify relationships between muscularity, preoperative nutritional markers, clinicopathologic parameters, and long-term survival. RESULTS: The psoas index correlated strongly with preoperative hemoglobin and albumin levels (P = .001 and .014, respectively) identifying a pattern of preoperative frailty. High psoas index and the albumin and hemoglobin levels were associated with improved long-term survival (hazard ratio 0.014, P < .001; hazard ratio 0.43, P < .001; and hazard ratio = 0.80, P = .014); however, on multivariate analysis, the psoas index proved to be the only independent predictor of survival (hazard ratio 0.021; P = .003). Rapid decreases in the psoas index during neoadjuvant chemotherapy were associated with poor postoperative outcomes, as were decreases in the psoas index during the postoperative period. CONCLUSION: The data indicate that the psoas index, a calculation derived from a clinically mandated, preoperative computed tomography, is a statistically powerful and easily calculated predictor of survival in pancreatic cancer when compared to tumor grade and stage as well as previously validated nutritional parameters.
Authors: David Hui; Carlos Eduardo Paiva; Egidio G Del Fabbro; Christopher Steer; Jane Naberhuis; Marianne van de Wetering; Paz Fernández-Ortega; Tatsuya Morita; Sang-Yeon Suh; Eduardo Bruera; Masanori Mori Journal: Support Care Cancer Date: 2019-03-13 Impact factor: 3.603
Authors: Rachel L Nosacka; Andrea E Delitto; Dan Delitto; Rohan Patel; Sarah M Judge; Jose G Trevino; Andrew R Judge Journal: J Cachexia Sarcopenia Muscle Date: 2020-02-10 Impact factor: 12.910
Authors: Jennifer B Permuth; Ashley Clark Daly; Daniel Jeong; Jung W Choi; Miles E Cameron; Dung-Tsa Chen; Jamie K Teer; Tracey E Barnett; Jiannong Li; Benjamin D Powers; Nagalakshmi B Kumar; Thomas J George; Karla N Ali; Tri Huynh; Shraddha Vyas; Clement K Gwede; Vani N Simmons; Pamela J Hodul; Estrella M Carballido; Andrew R Judge; Jason B Fleming; Nipun Merchant; Jose G Trevino Journal: Cancer Med Date: 2019-05-09 Impact factor: 4.452
Authors: Michael H Gerber; Patrick W Underwood; Sarah M Judge; Daniel Delitto; Andrea E Delitto; Rachel L Nosacka; Bayli B DiVita; Ryan M Thomas; Jennifer B Permuth; Steven J Hughes; Shannon M Wallet; Andrew R Judge; Jose G Trevino Journal: Int J Mol Sci Date: 2018-12-01 Impact factor: 5.923
Authors: Sarah M Judge; Rachel L Nosacka; Daniel Delitto; Michael H Gerber; Miles E Cameron; Jose G Trevino; Andrew R Judge Journal: JNCI Cancer Spectr Date: 2018-08-06
Authors: Chandler S Callaway; Andrea E Delitto; Rohan Patel; Rachel L Nosacka; Andrew C D'Lugos; Daniel Delitto; Michael R Deyhle; Jose G Trevino; Sarah M Judge; Andrew R Judge Journal: Cancers (Basel) Date: 2019-11-25 Impact factor: 6.639
Authors: Susan C Kandarian; Rachel L Nosacka; Andrea E Delitto; Andrew R Judge; Sarah M Judge; John D Ganey; Jesse D Moreira; Robert W Jackman Journal: J Cachexia Sarcopenia Muscle Date: 2018-09-30 Impact factor: 12.910
Authors: Patrick Naumann; Jonathan Eberlein; Benjamin Farnia; Jakob Liermann; Thilo Hackert; Jürgen Debus; Stephanie E Combs Journal: Cancers (Basel) Date: 2019-10-26 Impact factor: 6.639