Low preoperative skeletal muscle index increases the risk of mortality among resectable pancreatic cancer patients: A retrospective study

doi:10.4240/wjgs.v14.i12.1350

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Surg. Dec 27, 2022; 14(12): 1350-1362
Published online Dec 27, 2022. doi: 10.4240/wjgs.v14.i12.1350

Table 1 Patient and tumor characteristics comparing low and high skeletal muscle index or radiodensity

Characteristics	Total (n = 115)	Low SMI (n = 38)	High SMI (n = 77)	P value	Low SMD (n = 26)	High SMD (n = 89)	P value
Age	65.1 (9.0)	68.8 (9.3)	63.3 (8.4)	0.002^b	70.8 (7.0)	63.5 (8.9)	< 0.001^c
Male sex	71 (61.7)	29 (76.3)	42 (54.5)	0.024^a	13 (50.0)	58 (65.2)	0.162
BMI in kg/m²	22.7 (3.3)	20.9 (3.1)	23.6 (3.0)	< 0.001^c	24.0 (4.0)	22.3 (2.9)	0.016^a
< 20.0	21(18.3)	14 (36.8)	7 (9.1)		5 (19.2)	16 (18.0)
20.0-24.9	69 (60.0)	20 (52.6)	49 (63.6)		10 (38.5)	59 (66.3)
≥ 25.0	25 (21.7)	4 (10.5)	21 (27.3)	0.001^b	11 (42.3)	14 (15.7)	0.01^a
Albumin in g/dL	42.5 (5.6)	40.6 (4.1)	43.5 (6.1)	0.01^a	41.7 (7.7)	42.8 (4.9)	0.393
Tumor location
Head	67 (58.3)	29 (76.3)	38 (49.4)		18 (69.2)	49 (55.1)
Body + tail	48 (41.7)	9 (23.7)	39 (50.6)	0.006^b	8 (30.8)	40 (44.9)	0.197
Tumor size in cm	3.6 (1.4)	3.7 (1.7)	3.3 (1.2)	0.942	3.3 (1.3)	3.6 (1.4)	0.602
Differentiation
Well	5 (4.3)	1 (2.7)	4 (5.3)		3 (12.0)	4 (4.6)
Moderate	100 (87.0)	31 (83.8)	69 (92.0)		19 (76.0)	81 (93.1)
Poor	7 (6.1)	5 (13.5)	2 (2.7)	0.04^a	3 (12.0)	2 (2.3)	0.774
Nodal metastases	64 (55.7)	20 (52.6)	44 (57.1)	0.647	12 (46.2)	52 (58.4)	0.268
Perineural invasion¹	81 (86.2)	27 (87.1)	54 (85.7)	0.855	25 (100)	56 (81.2)	0.046^a
R1 resection	13 (11.3)	3 (7.9)	10 (13.2)	0.602	3 (11.5)	10 (11.4)	1.000
Adjuvant therapy	84 (73.0)	24 (63.2)	60 (77.9)	0.093	18 (69.2)	66 (74.2)	0.618
TNM stage
I	43 (37.4)	14 (36.8)	29 (37.7)		14 (53.8)	29 (32.6)
II	57 (49.6)	19 (50.0)	38 (49.4)		10 (38.5)	47 (52.8)
III	15 (13.0)	5 (13.1)	10 (13.0)	0.996	2 (7.6)	13 (14.6)	0.135
CA19-9 > 200 KU/L	71 (61.7)	24 (66.7)	47 (63.5)	0.746	21 (84.0)	50 (58.8)	0.021^a
SMA in cm²	123.0 (30.6)	108.4 (19.9)	130.2 (32.4)	< 0.001^c	113.2 (28.4)	125.9 (30.7)	0.056
SMD in HU	39.4 (8.6)	38.5 (10.0)	39.8 (7.8)	0.462	28.5 (5.1)	42.6 (6.5)	< 0.001^c
SMI in cm²/m²	44.6 (9.8)	38.1 (5.3)	47.7 (10.0)	< 0.001^c	41.1 (9.0)	45.6 (9.9)	0.033^a
VAT in cm²	113.4 (66.5)	89 (50.2)	125.4 (70.5)	< 0.001^c	151.0 (60.2)	102.4 (64.5)	0.001^b
SAT in cm²	121.4 (64.6)	100.5 (45.4)	131.7 (70.2)	0.014^a	160.0 (89.3)	110.1 (50.7)	< 0.001^c
NLR > 2.6	44 (38.3)	16 (42.1)	28 (36.4)	0.551	13 (50.0)	31 (34.8)	0.162
PLR > 108	77 (67.0)	27 (71.1)	50 (64.9)	0.512	21 (80.8)	56 (62.9)	0.089
SIII > 400	68 (59.1)	24 (63.2)	44 (57.1)	0.537	17 (65.4)	51 (57.3)	0.461

¹Data were available for 94 patients. Statistics are presented as the means (standard deviations) for age, body mass index, albumin, tumor size, and body composition parameters and n (%) for the other parameters.

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

SMA: Skeletal muscle area; SMD: Skeletal muscle radiodensity; HU: Hounsfield units; SMI: Skeletal muscle index; VAT: Visceral adipose tissue; SAT: Subcutaneous adipose tissue; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; SIII: Systemic immune-inflammation index; BMI: Body mass index; CA19-9: Carbohydrate antigen 19-9.

Table 2 Univariate and multivariate analyses of risk factors for overall survival following pancreatic cancer resection

Factor	Univariate analysis	P value	Multivariate analysis	P value
Factor	HR (95%CI)	P value	HR (95%CI)	P value
Age ≥ 65 yr	1.661 (0.905-3.051)	0.102
Male sex	0.686 (0.371-1.267)	0.228
BMI < 20.0 underweight	0.534 (0.262-1.085)	0.083
BMI ≥ 25.0 obesity	0.631 (0.322-1.233)	0.178
Albumin < 3.8 g/dL	1.146 (0.550-2.388)	0.716
Low SMI	2.805 (1.559-5.045)	0.001^b	2.307 (1.210-4.402)	0.011^a
Low SMD	2.395 (1.261-4.550)	0.008^b	2.093 (1.000-4.379)	0.05
Tumor location, head	1.620 (0.870-3.019)	0.128
Tumor size > 2 cm	1.107 (0.494-2.480)	0.805
Differentiation poor	3.102 (0.947-10.158)	0.061
Nodal metastases	1.853 (1.022-3.358)	0.042^a	2.308 (1.200-4.442)	0.012^a
Perineural invasion	2.303 (0.701-7.564)	0.169
R1 Resection	1.165 (0.415-3.267)	0.772
TNM stage III	1.515 (0.673-3.414)	0.316
Adjuvant therapy	0.528 (0.284-0.980)	0.043^a	0.480 (0.242-0.952)	0.036^a
CA19-9 > 200 KU/L	1.891 (1.021-3.504)	0.043^a	0.851 (0.428-1.689)	0.644
NLR > 2.6	1.630 (0.911-2.916)	0.099
PLR > 108	2.208 (1.150-4.238)	0.017^a	1.296 (0.517-3.250)	0.58
SIII > 400	1.911 (1.044-3.500)	0.036^a	1.338 (0.586-3.057)	0.489

^aP < 0.05.

^bP < 0.01.

HR: Hazard ratio; BMI: Body mass index; CA19-9: Carbohydrate antigen 19-9; NLR: Neutrophil-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; SIII: Systemic immune-inflammation index; SMI: Skeletal muscle index; SMD: Skeletal muscle radiodensity; CI: Confidence interval.

Table 3 Univariate and multivariate analysis of risk factors for recurrence-free survival following pancreatic cancer resection

Factor	Univariate analysis	P value	Multivariate analysis	P value
Factor	HR (95%CI)	P value	HR (95%CI)	P value
Age > 65 yr	1.661 (0.905-3.051)	0.102
Male sex	0.631 (0.382-1.041)	0.071
BMI < 20.0 underweight	1.216 (0.660-2.240)	0.530
BMI ≥ 25.0 obesity	1.823 (0.969-3.430)	0.062
Albumin < 3.8 g/dL	0.871 (0455-1.668)	0.677
Low SMI	1.784 (1.083-2.939)	0.023^a	1.907 (1.147-3.171)	0.013^a
Low SMD	1.567 (0.885-2.773)	0.123
Tumor location, head	1.327 (0.795-2.215)	0.278
Tumor size > 2 cm	1.611 (0.767-3.382)	0.208
Differentiation poor	0.978 (0.238-4.022)	0.976
Nodal metastases	1.897 (1.134-3.174)	0.015^a	1.922 (1.129-3.272)	0.016^a
Perineural invasion	1.886 (0.841-4.231)	0.124
R1 Resection	1.593 (0.754-3.365)	0.222
TNM stage III	1.703 (0.833-3.483)	0.144
Adjuvant therapy	0.866 (0.479-1.567)	0.635
CA19-9 in Ku/L > 200	1.439 (0.855-2.421)	0.170
NLR > 2.6	1.071 (0.648-1.769)	0.789
PLR > 108	1.612 (0.955-2.722)	0.074
SIII > 400	1.827 (1.097-3.043)	0.021^a	1.655 (0.984-2.785)	0.058
Platelets > 310 × 10⁹	1.245 (0.533-2.910)	0.613

^aP < 0.05.

Citation: Cai ZW, Li JL, Liu M, Wang HW, Jiang CY. Low preoperative skeletal muscle index increases the risk of mortality among resectable pancreatic cancer patients: A retrospective study. World J Gastrointest Surg 2022; 14(12): 1350-1362
URL: https://www.wjgnet.com/1948-9366/full/v14/i12/1350.htm
DOI: https://dx.doi.org/10.4240/wjgs.v14.i12.1350