Sarcopenia in pancreatic cancer – effects on surgical outcomes and chemotherapy

Table 1 Diagnostic criteria for sarcopenia by various working groups

	Criteria	Remarks
European Working Group on Sarcopenia in Older People, 2010[16]	1 Low muscle strength	Probable sarcopenia is identified by Criterion 1
	2 Low muscle quantity or quality	Diagnosis is confirmed by additional documentation of Criterion 2
	3 Low physical performance	Sarcopenia is considered severe if all 3 criteria are met
ESPEN Special Interest Group, 2010[18]	1 Low muscle mass	Cut-off point should be more than 2 standard deviations below mean value of reference population using young adults of the same sex and ethnic background
	2 Walking speed < 0.8 m/s in the 4-min test or reduced performance in functional test	Functional test can be any test used for comprehensive geriatric assessment Both criteria should be present
International Working Group on Sarcopenia, 2011[17]	1 Gait speed < 1 m/s 2 Lean mass less than the 20th percentile of values for healthy young adults	Both criteria should be present
European Working Group on Sarcopenia in Older People, 2018 [2]	1 Low muscle mass	Cut-off point should be more than 2 standard deviations below mean value of reference population using healthy young adults of the same ethnic background
	2 Low muscle strengt	Diagnosis is based on documentation of Criterion 1 plus Criterion 2 or Criterion 3
	3 Low physical performance
Society of Sarcopenia, Cachexia and Wasting Disorders, 2011[19]	1 Walking speed ≤ 1 m/s or < 400 m during 6-min walk	Both criteria should be present
	2 Lean appendicular mass corrected for height squared of more than 2 standard deviations below healthy adults of 20–30 years old of the same ethnic group

Table 2 Summary of long-term survival outcomes in sarcopenic patients in eight studies

Ref.	No. of patients	Indication	Operation	Assessment of sarcopenia	Cut-off points for sarcopenia	Outcomes		P value
Peng et al[14], 2012	557	Pancreatic cancer	PD and DP	Total psoas index	Lowest quartile of the study cohort	3-yr survival, male	Sarcopenic: 20.3% Non-sarcopenic: 39.2%	< 0.05
						3-yr survival, female	Sarcopenic: 26.1% Non-sarcopenic: 40.8%	< 0.05
Amini et al[31], 2015	763	Pancreatic adenocarcinoma	PD, DP and TP	Total psoas volume (adjusted for height), total psoas index	Cut-off value from Peng et al[14]	OS	Sarcopenia as independent risk factor	< 0.001
							UV: HR 1.72, 95%CI: 1.36–2.19 MV: HR 1.11, 95%CI: 1.11–1.91	0.006
Joglekar et al[46], 2015	180	Pancreatic adenocarcinoma	PD and DP	Total psoas index	Lowest quartile of the study cohort	OS	No significant difference	0.44
Okumura et al[45], 2015	230	Pancreatic adenocarcinoma	PD, DP and TP	Total psoas index (measured at umbilical level)	Calculated from receiver-operating characteristic curves	Median OS	Sarcopenic: 17.7 mo Non-sarcopenic: 33.2 mo	< 0.001
						DFS	Significantly shorter survival in sarcopenic group	< 0.001
Onesti et al[66], 2016	270	Both benign and malignant conditions	PD, DP, central and TP	Total psoas area	Lowest tertile of the study cohort	OS	Significantly worse survival for sarcopenic group in females only	0.005
Ninomiya et al[67], 2017	265	Pancreatic adenocarcinoma	PD, DP and TP	Total abdominal muscle area (adjusted for height)	Cut-off value from Prado et al[39]	Median OS	Sarcopenic: 23.7 mo Non-sarcopenic: 25.8 mo	0.185
Van Dijk et al[47], 2017	199	Cancer of pancreatic head, ampulla, distal bile duct or duodenum	PD	Total abdominal muscle area (adjusted for height), radiation attenuation of skeletal muscle at L3	Lowest tertile of the study cohort	Median OS	No difference when total abdominal muscle area was compared	Not reported
							Significantly shorter survival in patients with low radiation attenuation	0.008
Sugimoto et al[68], 2018	323	Pancreatic adenocarcinoma	PD, DP and TP	Total abdominal muscle area (adjusted for height)	Cut-off value from Fearon et al[29]	OS	No significant difference	0.412
						DFS	No significant difference	0.390
					Lowest quartile from study cohort	OS	No significant difference	0.075
						DFS	No significant difference	0.172

PD: Pancreaticoduodenectomy; DP: Distal pancreatectomy; TP: Total pancreatectomy; OS: Overall survival; DFS: Disease-free survival; UV: Univariate analysis; HR: Hazard ratio; CI: Confidence interval; MV: Multivariate analysis.