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.
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Article info
Publication history
Published online: December 05, 2016
Accepted:
September 7,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
