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Copyright ©The Author(s) 2022.
World J Gastrointest Oncol. Dec 15, 2022; 14(12): 2302-2312
Published online Dec 15, 2022. doi: 10.4251/wjgo.v14.i12.2302
Table 1 Studies analyzing the effect of sarcopenia on surgical outcomes of pancreatic cancer
Ref.CountryNo. of patientsImaging modalityLevelTimeDefinition and cutoffSarcopenia prevalence before surgeryTypes of surgeryPerioperative complicationsSurvivalAdditional meaningful findings or comments
Peng et al[24], 2012United States557CTL3Before surgeryTPAI (mm2/m2), lowest quartile: < 564.2 (M), < 414.5 (F)25%PD, DP(-)(+) OSSarcopenia was an independent predictor of survival in multivariable analysis
Amini et al[7], 2015United States763CTL3Before surgeryTPAI (mm2/m2), < 564.2 (M), 414.5 (F); TPVI (cm³/m2), < 17.2 (M), < 12.0 (F)25% by TPAI, 20% by TPVIPD, DP. TP(+) Overall Cx. by TPVI(+) OS by TPVITPVI was a better measure for defining sarcopenia rather than TPAI
Pecorelli et al[9], 2016Italy202CTL3Before surgeryLSMI, < 52.4 cm2/m2 (M), < 38.5 cm2/m2 (F)165%PD(-)NEThe combination of visceral obesity and sarcopenia was a predictor of perioperative Cx
Ninomiya et al[28], 2017Japan265CTL3Before surgeryLSMI, < 43.75 cm2/m2 (M), < 38.5 cm2/m2 (F)64%PD, DP. TP(-)(-)Sarcopenia was an independent prognostic factor only in patients with BMI ≥ 22 kg/m2
Okumura et al[29], 2017 Japan301CTL3Before surgeryLSMI, clinically relevant cutoff: < 47.1 cm2/m2 (M), < 36.6 cm2/m2 (F)40%PD, DP. TP(-)(+) OS and RFSLow muscle attenuation, as well as low muscle mass, was associated with worse OS and RFS
Choi et al[18], 2018 South Korea180CTL3Before and after 60 d of surgeryLSMI, the lowest tertile; < 45.3 cm2/m2 (M), < 39.3 cm2/m2 (F)33%PD, DP(-)(+) OSAccelerated muscle loss after surgery negatively impacts OS
Sugimoto et al[19], 2018 United States323CTL3Before surgeryLSMI, < 55.4 cm2/m2 (M), < 38.9 cm2/m2 (F)62%PD, DP. TPNE(-)Smaller sex-standardized LSMI as a continuous variable is associated with a shorter OS
Gruber et al[10], 2019 Austria133CTL3Before surgeryLSMI, < 52.4 cm2/m2 (M), < 38.5 cm2/m2 (F)159%PD, DP(-)(+) OSObese patients (BMI ≥ 25) with sarcopenia have higher incidence of major post-operative Cx
Ryu et al[30], 2020 South Korea548CTL3Before surgeryLSMI, < 50.18 cm2/m2 (M), < 38.63 cm2/m2 (F)46%PD(-)(+) OS Sarcopenic obesity is a predictive factor for post-operative pancreatic fistula after PD
Rom et al[25], 2022 Israel111CTL3Before surgeryLSMI, the lowest quartile: < 44; 35 cm2/m2 (M), < 34.82 cm2/m2 (F)25%PD, DP(+) Overall Cx.(+) OS, DSS, and RFSHigh intramuscular adipose tissue content correlates with poor OS and DSS
Table 2 Studies analyzing the effect of sarcopenia on neoadjuvant therapy outcomes of pancreatic cancer
Ref.
Country
No. of patients
Inclusion
Imaging modality
Level
Time
Definition and cutoff
Sarcopenia prevalence before NAT
Resectability
Survival
Additional meaningful findings or comments
Cooper et al[35], 2015 United States89RPCCTL3Before and after NATLSMI, < 55.4 cm2/m2 (M), < 38.9 cm2/m2 (F)55%(-)(-)SKM loss during NAT was correlated with DFS
Cloyd et al[36], 2018 United States127RPC, BRPC, LAPCCTL3Before and after NAT, 3 mo and 12 mo after surgery (PD)LSMI, < 55.4 cm2/m2 (M), < 38.9 cm2/m2 (F)63%NE(-)SKM gain between the postoperative period and 1-yr follow-up was correlated with improved OS
Sandini et al[13], 2018 United States and Italy193BRPC, LAPCCTL3Before and after NATLSMI, < 43 cm2/m2 (M) where BMI < 25 kg/m2, < 53 cm2/m2 (M) where BMI > 25 kg/m2, < 41 cm2/m2 (F)144%(-)NESKM gain during NAT is correlated with better resectability
Griffin et al[14], 2019 Ireland78BRPCCTL3Before and after NATLSMI, < 43 cm2/m2 (M) where BMI < 25 kg/m2, < 53 cm2/m2 (M) where BMI > 25 kg/m2, < 41 cm2/m2 (F)150%(-)(-)Low muscle attenuation before NAT and SKM loss during NAT was correlated with decreased OS
Takeda et al[15], 2021 Japan62RPCCTL3Before NATLSMI, < 43 cm2/m2 (M) where BMI < 25 kg/m2, < 53 cm2/m2 (M) where BMI > 25 kg/m2, < 41 cm2/m2 (F)140%(-)NESarcopenia before NAT did not correlate with antitumor response and toxicity of therapy
Jin et al[37], 2022 China119RPCCTL3Before and after NATLSMI, < 41 cm2/m2 (M), < 38.5 cm2/m2 (F) 48%NE(+) OS, DFSSKM and fat wasting during NAT was correlated with decreased OS and DFS
Table 3 Studies analyzing the effect of sarcopenia on palliative chemotherapy outcomes of pancreatic cancer
Ref.
Country
No. of patients
Inclusion (%)
Imaging modality
Level
Time
Definition and cutoff
Sarcopenia prevalence before CTX
CTX regimen
CTX toxicity
PFS
OS
Additional meaningful findings or comments
Kays et al[11], 2018 United States53LAPC (49), MPC (51)CTL3Before and during CTX (median 5.6 times)LSMI, < 52.4 cm2/m2 (M), < 38.5 cm2/m2 (F)149%1st line FOLFIRINOXNENE(-)No muscle wasting during CTX improved OS
Basile et al[16], 2019 Italy94LAPC (50), MPC (50)CTL3Before and after 12 wk of CTXLSMI, < 43 cm2/m2 (M) where BMI < 25 kg/m2, < 53 cm2/m2 (M) where BMI > 25 kg/m2, < 41 cm2/m2 (F)273%VariousNE(-)(-)Loss of skeletal muscle mass (≥ 10%) was associated with worse OS and PFS
Kurita et al[38], 2019 Japan82LAPC (35), MPC (65)CTL3Before CTXLSMI, clinically relevant cut-off: < 45.3 cm2/m2 (M), < 37.1 cm2/m2 (F)51%1st line FOLFIRINOX(-)(+)(+)Sarcopenic obesity was associated with hematologic toxicity
Lee et al[39], 2019South Korea57LAPC (5), MPC (95)CTL3Before and after 8 wk of CTXLSMI, median level: unknown50%2nd line FOLFIRINOXNE(+)(+)Baseline LSMI was an independent predictor of survival in multivariable analysis
Kim et al[17], 2021 South Korea251MPC (100)CTL3Before and after 8 wk of CTXLSMI, < 43 cm2/m2 (M) where BMI < 25 kg/m2, < 53 cm2/m2 (M) where BMI > 25 kg/m2, < 41 cm2/m2 (F)241%1st line gemcitabine-based CTX(+) Overall grade ≥ 3 toxicity(-)(-)Sarcopenia was a prognostic factor for OS but not for PFS in multivariable analysis
Uemura et al[21], 2021 Japan69LAPC (29), MPC (71)CTL3Before and after 8 wk of CTXLSMI, < 42 cm2/m2 (M), < 38 cm2/m2 (F)3 48%1st line FOLFIRINOX(-)(-)(-)Loss of skeletal muscle mass (≥ 7.9%) is associated with worse OS
Williet et al[40], 2021 France79MPC (100)CTL3Before CTXTPAI, clinically relevant cutoff: 5.73 cm2/m2 (M), 4.37 cm2/m2 (F)38%Various(-)(+)(+)Measuring TPAI was less time-consuming than measuring LSMI
Asama et al[22], 2022 Japan124LAPC (29), MPC (60), RePC (15)CTL3Before CTXLSMI, < 42 cm2/m2 (M), < 38 cm2/m2 (F)349%1st line Gem-Nab(-)(-)(-)In elderly patients (> 70 yr), sarcopenia was associated with worse OS
Emori et al[23], 2022 Japan176LAPC (14), MPC (86)CTL3Before CTXLSMI, < 42 cm2/m2 (M), < 38 cm2/m2 (F)353%1st line Gem-Nab(+) Overall grade ≥ 3 toxicity(+)(+)Propensity score matching analysis was performed