A. Sagnotta1, F. Carbonetti1, M. De Siena1, L. Mangogna1, C. Mattana1, P. Magistri1, G. Ramacciato1, G. Nigri1 1Sapienza University Of Rome,Department Of Medical And Surgical Sciences And Traslational Medicine,Rome, RM, Italy
Introduction: Sarcopenia is a surrogate marker of patient frailty that estimates the physiologic reserve of an individual patient. Few studies have examined the association between the presence of sarcopenia and outcomes following pancreatic surgery. These studies had traditionally defined sarcopenia measuring total psoas area (TPA) or volume (TPV). However, the entire skeletal muscle area (SMA) to the midpoint of L3 vertebral body is considered a more objective measure of sarcopenia. The aim of this study was to evaluate the prevalence of sarcopenia and to investigate its impact on long-term outcomes in patients who underwent pancreatectomy for tumor.
Methods: One hundred and six patients who underwent pancreatectomy for malignancy between 2003 and 2014 met the inclusion criteria. The skeletal muscle area (SMA) was measured on perioperative CT scans at the level of the third lumbar vertebra (L3). The L3 SMA (cm2) was normalized by the square of the height (m2) to obtain the skeletal muscle index (L3 SMI, cm2/m2). We established different gender specific cut-offs using the ROC curve method (43.35 cm2/m2in men and 34 cm2/m2 in women, respectively). The prevalence and impact of sarcopenia was assessed relatively to other clinic-pathological factors. Univariate and multivariate analyses evaluating prognostic factors of overall survival were performed, including preoperative, surgical and histopathological factors.
Results: Mean age was 67.4 years and 52.1% was female. Pancreatic cancer represents 69.9% of all cases. Pancreatoduodenectomy was performed in 81.5% and an R0 resection was obtained in 114 cases (78.1%). Mean SMI was lower in women (32.8 cm2/m2) versus men (41.1 cm2/m2, p<0.0001); 97 patients (66.4%) were sarcopenic, 66 (45.2%) were overweight/obese and 34 (23.3%) were both (p=0.003). Sarcopenia was significantly related to histology (p=0.031), body mass index (p<0.001), lower value of albumin (p=0.002), modified Glasgow Prognostic Score (mGPS, p=0.036) and prognostic nutritional index (PNI, p=0.003). Overall morbidity was 41.8% and 90-days mortality was 6.8%. Overall survival (OS) was significantly shorter in sarcopenic patients than in non-sarcopenic patients (3-year OS 60.3vs 35.6% and 5-year 47.5 vs 20.7%, log-rank p=0.008). In multivariate Cox regression analysis, sarcopenia remained independently associated with poor overall survival (HR 2.178; 95% CI 1.11-4.273; p=0.024).
Conclusion: Sarcopenia, as assessed by L3 SMI, was found in 66.4% of patients underwent pancreatectomy. It was correlated to worse nutritional status and could be a more objective measure of patient frailty even in overweight/obese patients. This condition independently impacts survival and may be a useful preoperative tool for clinical decision-making in patients undergoing curative pancreatic resection.