Skip to content
2000
Volume 21, Issue 1
  • ISSN: 1573-4056
  • E-ISSN: 1875-6603
file format pdf download PDF
file format text download EPUB
side by side viewer icon HTML

Abstract

Purpose

The study aimed to investigate the association of CT-relevant skeletal muscle parameters, such as sarcopenia and myosteatosis, with survival outcomes in patients receiving chemotherapy for unresectable pancreatic ductal adenocarcinoma (PDAC).

Methods

In this retrospective analysis, patients who began chemotherapy for unresectable PDAC were included. Sarcopenia and myosteatosis were assessed on pretreatment CT at the L3 level by skeletal muscle index and mean muscle attenuation with predefined cutoff values. The Cox proportional hazards model was used to analyze the factors associated with progression-free survival (PFS) and overall survival (OS).

Results

A total of 150 patients were enrolled. Compared to patients without sarcopenia, patients with sarcopenia had significantly worse PFS (p=0.003) and OS (p<0.001). Patients with myosteatosis had significantly worse PFS (p=0.01) and OS (p=0.002) compared to those without myosteatosis. In multivariate analysis, after adjusting for age, sex, tumor size, location, treatment modality, smoking, drinking, underlying diseases, and partial laboratory tests, sarcopenia remained an independent predictor of PFS (p=0.006) and OS (p<0.001). Myosteatosis remained an independent predictor of OS (p=0.008), but not of PFS.

Conclusion

Sarcopenia and myosteatosis are independent prognostic factors for patients with unresectable pancreatic ductal adenocarcinoma after chemotherapy.

© 2025 The Author(s).
© 2025 The Author(s). Published by Bentham Science Publishers. This is an open access article published under CC BY 4.0 https://creativecommons.org/licenses/by/4.0/legalcode
Loading

Article metrics loading...

/content/journals/cmir/10.2174/0115734056356822250205174104
2025-01-01
2025-10-19

  • From This Site

    /content/journals/cmir/10.2174/0115734056356822250205174104
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

/deliver/fulltext/cmir/21/1/CMIR-21-E15734056356822.html?itemId=/content/journals/cmir/10.2174/0115734056356822250205174104&mimeType=html&fmt=ahah

References

  1. HalbrookC.J. LyssiotisC.A. Pasca di MaglianoM. MaitraA. Pancreatic cancer: Advances and challenges.Cell202318681729175410.1016/j.cell.2023.02.01437059070
     [Google Scholar]
  2. EmoriT. ItonagaM. AshidaR. TamuraT. KawajiY. HatamaruK. YamashitaY. ShimokawaT. KoikeM. SonomuraT. KawaiM. KitanoM. Impact of sarcopenia on prediction of progression-free survival and overall survival of patients with pancreatic ductal adenocarcinoma receiving first-line gemcitabine and nab-paclitaxel chemotherapy.Pancreatology202222227728510.1016/j.pan.2021.12.01335033425
     [Google Scholar]
  3. HouY.C. ChenC.Y. HuangC.J. WangC.J. ChaoY.J. ChiangN.J. WangH.C. TungH.L. LiuH.C. ShanY.S. The differential clinical impacts of cachexia and sarcopenia on the prognosis of advanced pancreatic cancer.Cancers20221413313710.3390/cancers1413313735804906
     [Google Scholar]
  4. ChenL.K. LiuL.K. WooJ. AssantachaiP. AuyeungT.W. BahyahK.S. ChouM.Y. ChenL.Y. HsuP.S. KrairitO. LeeJ.S.W. LeeW.J. LeeY. LiangC.K. LimpawattanaP. LinC.S. PengL.N. SatakeS. SuzukiT. WonC.W. WuC.H. WuS.N. ZhangT. ZengP. AkishitaM. AraiH. Sarcopenia in Asia: Consensus report of the Asian working group for sarcopenia.J. Am. Med. Dir. Assoc.20141529510110.1016/j.jamda.2013.11.02524461239
     [Google Scholar]
  5. Cruz-JentoftA.J. BaeyensJ.P. BauerJ.M. BoirieY. CederholmT. LandiF. MartinF.C. MichelJ.P. RollandY. SchneiderS.M. TopinkováE. VandewoudeM. ZamboniM. European Working Group on Sarcopenia in Older People Sarcopenia: European consensus on definition and diagnosis.Age Ageing201039441242310.1093/ageing/afq03420392703
     [Google Scholar]
  6. TakedaT. SasakiT. OkamotoT. IshitsukaT. YamadaM. NakagawaH. MieT. FurukawaT. KasugaA. MatsuyamaM. OzakaM. SasahiraN. Prognostic impact of osteosarcopenia in patients with advanced pancreatic cancer receiving gemcitabine plus nab-paclitaxel.Pancreatology202323327528210.1016/j.pan.2023.02.00236792473
     [Google Scholar]
  7. LelloucheL. BaratM. PellatA. LerouxJ. CorreF. HallitR. AssafA. BrezaultC. DhoogeM. SoyerP. CoriatR. Impact of sarcopenia on survival in patients treated with FOLFIRINOX in a first-line setting for metastatic Pancreatic carcinoma.J. Clin. Med.2023126221110.3390/jcm1206221136983212
     [Google Scholar]
  8. ÖzkulB. ÖzkulÖ. BilirC. Predicting the overall survival in patients with advanced pancreatic cancer by calculating L3 skeletal muscle index derived from CT.Curr. Med. Imaging Rev.202218101079108510.2174/157340561866622030310541035240961
     [Google Scholar]
  9. ChenB.B. LiangP.C. ShihT.T.F. LiuT.H. ShenY.C. LuL.C. LinZ.Z. HsuC. HsuC.H. ChengA.L. ShaoY.Y. Sarcopenia and myosteatosis are associated with survival in patients receiving immunotherapy for advanced hepatocellular carcinoma.Eur. Radiol.202233151252210.1007/s00330‑022‑08980‑435864351
     [Google Scholar]
  10. KanoM. HiharaJ. TokumotoN. KohashiT. HaraT. ShimbaraK. TakahashiS. Association between skeletal muscle loss and the response to nivolumab immunotherapy in advanced gastric cancer patients.Int. J. Clin. Oncol.202126352353110.1007/s10147‑020‑01833‑433226523
     [Google Scholar]
  11. KimY.Y. LeeJ. JeongW.K. KimS.T. KimJ.H. HongJ.Y. KangW.K. KimK.M. SohnI. ChoiD. Prognostic significance of sarcopenia in microsatellite-stable gastric cancer patients treated with programmed death-1 inhibitors.Gastric Cancer202124245746610.1007/s10120‑020‑01124‑x32970267
     [Google Scholar]
  12. NishiokaN. NaitoT. NotsuA. MoriK. KodamaH. MiyawakiE. MiyawakiT. MamesayaN. KobayashiH. OmoriS. WakudaK. OnoA. KenmotsuH. MurakamiH. TakayamaK. TakahashiT. Unfavorable impact of decreased muscle quality on the efficacy of immunotherapy for advanced non‐small cell lung cancer.Cancer Med.202110124725610.1002/cam4.363133300678
     [Google Scholar]
  13. BilenM.A. MartiniD.J. LiuY. ShabtoJ.M. BrownJ.T. WilliamsM. KhanA.I. SpeakA. LewisC. CollinsH. KissickH.T. CarthonB.C. AkceM. ShaibW.L. AleseO.B. PillaiR.N. SteuerC.E. WuC.S. LawsonD.H. KudchadkarR.R. El-RayesB.F. RamalingamS.S. OwonikokoT.K. HarveyR.D. MasterV.A. Combined effect of sarcopenia and systemic inflammation on survival in patients with advanced stage cancer treated with immunotherapy.Oncologist2020253e528e53510.1634/theoncologist.2019‑075132162807
     [Google Scholar]
  14. CefalìM. ScalaI. PavoneG. HelblingD. HussungS. FritschR. ReinerC. StockerS. KoeberleD. KisslingM. ChiancaV. Del GrandeF. De DossoS. RizzoS. Is computed-tomography-based body composition a reliable predictor of chemotherapy-related toxicity in pancreatic cancer patients?Cancers20231517439810.3390/cancers1517439837686674
     [Google Scholar]
  15. StenholmS. HarrisT.B. RantanenT. VisserM. KritchevskyS.B. FerrucciL. Sarcopenic obesity: Definition, cause and consequences.Curr. Opin. Clin. Nutr. Metab. Care200811669370010.1097/MCO.0b013e328312c37d18827572
     [Google Scholar]
  16. PradoC.M.M. LieffersJ.R. McCargarL.J. ReimanT. SawyerM.B. MartinL. BaracosV.E. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: A population-based study.Lancet Oncol.20089762963510.1016/S1470‑2045(08)70153‑018539529
     [Google Scholar]
  17. YoungA.C. QuachH.T. SongH. DavisE.J. MoslehiJ.J. YeF. WilliamsG.R. JohnsonD.B. Impact of body composition on outcomes from anti-PD1 +/− anti-CTLA-4 treatment in melanoma.J. Immunother. Cancer202082e00082110.1136/jitc‑2020‑00082132747470
     [Google Scholar]
  18. AhnH. KimD.W. KoY. HaJ. ShinY.B. LeeJ. SungY.S. KimK.W. Updated systematic review and meta-analysis on diagnostic issues and the prognostic impact of myosteatosis: A new paradigm beyond sarcopenia.Ageing Res. Rev.20217010139810.1016/j.arr.2021.10139834214642
     [Google Scholar]
  19. LeeC.M. KangJ. Prognostic impact of myosteatosis in patients with colorectal cancer: A systematic review and meta‐analysis.J. Cachexia Sarcopenia Muscle20201151270128210.1002/jcsm.1257532483936
     [Google Scholar]
  20. AleixoG.F.P. ShacharS.S. NyropK.A. MussH.B. MalpicaL. WilliamsG.R. Myosteatosis and prognosis in cancer: Systematic review and meta-analysis.Crit. Rev. Oncol. Hematol.202014510283910.1016/j.critrevonc.2019.10283931877534
     [Google Scholar]
  21. SchwartzL.H. LitièreS. de VriesE. FordR. GwytherS. MandrekarS. ShankarL. BogaertsJ. ChenA. DanceyJ. HayesW. HodiF.S. HoekstraO.S. HuangE.P. LinN. LiuY. TherasseP. WolchokJ.D. SeymourL. RECIST 1.1—Update and clarification: From the RECIST committee.Eur. J. Cancer20166213213710.1016/j.ejca.2016.03.08127189322
     [Google Scholar]
  22. PengY.C. WuC.H. TienY.W. LuT.P. WangY.H. ChenB.B. Preoperative sarcopenia is associated with poor overall survival in pancreatic cancer patients following pancreaticoduodenectomy.Eur. Radiol.20213142472248110.1007/s00330‑020‑07294‑732974690
     [Google Scholar]
  23. SuH. RuanJ. ChenT. LinE. ShiL. CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: A systematic review and meta-analysis.Cancer Imaging20191918210.1186/s40644‑019‑0270‑031796090
     [Google Scholar]
  24. HuangD.D. ZhouC.J. WangS.L. MaoS.T. ZhouX.Y. LouN. ZhangZ. YuZ. ShenX. ZhuangC.L. Impact of different sarcopenia stages on the postoperative outcomes after radical gastrectomy for gastric cancer.Surgery2017161368069310.1016/j.surg.2016.08.03027712873
     [Google Scholar]
  25. KurkS.A. PeetersP.H.M. DorresteijnB. de JongP.A. JourdanM. KuijfH.J. PuntC.J.A. KoopmanM. MayA.M. Impact of different palliative systemic treatments on skeletal muscle mass in metastatic colorectal cancer patients.J. Cachexia Sarcopenia Muscle20189590991910.1002/jcsm.1233730144305
     [Google Scholar]
  26. ChunY.S. PawlikT.M. VautheyJ-N. 8th edition of the AJCC cancer staging manual: Pancreas and hepatobiliary cancers.Ann. Surg. Oncol.20182584584710.1245/s10434‑017‑6025‑x
     [Google Scholar]
  27. FearonK. StrasserF. AnkerS.D. BosaeusI. BrueraE. FainsingerR.L. JatoiA. LoprinziC. MacDonaldN. MantovaniG. DavisM. MuscaritoliM. OtteryF. RadbruchL. RavascoP. WalshD. WilcockA. KaasaS. BaracosV.E. Definition and classification of cancer cachexia: An international consensus.Lancet Oncol.201112548949510.1016/S1470‑2045(10)70218‑721296615
     [Google Scholar]
  28. MatsunagaT. SatioH. SakanoY. MakinoyaM. ShimizuS. ShishidoY. MiyataniK. HanakiT. KiharaK. YamamotoM. TokuyasuN. TakanoS. SakamotoT. HasegawaT. FujiwaraY. Prognostic significance of the cachexia index in patients with unresectable advanced gastric cancer receiving palliative chemotherapy: A retrospective single-center study.Surg. Today202454323123910.1007/s00595‑023‑02721‑w37526733
     [Google Scholar]
  29. AprileG. BasileD. GiarettaR. SchiavoG. La VerdeN. CorradiE. MongeT. AgustoniF. StragliottoS. The clinical value of nutritional care before and during active cancer treatment.Nutrients2021134119610.3390/nu1304119633916385
     [Google Scholar]
  30. AsamaH. UenoM. KobayashiS. FukushimaT. KawanoK. SanoY. TanakaS. NagashimaS. MorimotoM. OhiraH. MaedaS. Sarcopenia.Pancreas202251214815210.1097/MPA.000000000000198535404889
     [Google Scholar]
  31. JinK. TangY. WangA. HuZ. LiuC. ZhouH. YuX. Body composition and response and outcome of neoadjuvant treatment for pancreatic cancer.Nutr. Cancer202274110010910.1080/01635581.2020.187070433629916
     [Google Scholar]
  32. StretchC. AubinJ.M. MickiewiczB. LeugnerD. Al-manasraT. TobolaE. SalazarS. SutherlandF.R. BallC.G. DixonE. VogelH.J. DamarajuS. BaracosV.E. BatheO.F. Sarcopenia and myosteatosis are accompanied by distinct biological profiles in patients with pancreatic and periampullary adenocarcinomas.PLoS One2018135e019623510.1371/journal.pone.019623529723245
     [Google Scholar]
  33. LattanziB. NardelliS. PigliacelliA. Di ColaS. FarcomeniA. D’AmbrosioD. GioiaS. Ginanni CorradiniS. LucidiC. MenniniG. RossiM. MerliM. RiggioO. The additive value of sarcopenia, myosteatosis and hepatic encephalopathy in the predictivity of model for end-stage liver disease.Dig. Liver Dis.201951111508151210.1016/j.dld.2019.09.00431601536
     [Google Scholar]
  34. CziganyZ. KrampW. BednarschJ. van der KroftG. BoeckerJ. StrnadP. ZimmermannM. KoekG. NeumannU.P. LurjeG. Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation.Am. J. Transplant.202020249350310.1111/ajt.1557731448486
     [Google Scholar]
  35. HamaguchiY. KaidoT. OkumuraS. KobayashiA. ShiraiH. YaoS. YagiS. KamoN. SeoS. TauraK. OkajimaH. UemotoS. Preoperative visceral adiposity and muscularity predict poor outcomes after hepatectomy for hepatocellular carcinoma.Liver Cancer2019829210910.1159/00048877931019900
     [Google Scholar]
  36. YounS. ReifR. ChuM.P. SmylieM. WalkerJ. EurichD.T. GhoshS. SawyerM.B. Myosteatosis is prognostic in metastatic melanoma treated with nivolumab.Clin. Nutr. ESPEN20214234835310.1016/j.clnesp.2021.01.00933745604
     [Google Scholar]
  37. VanderVeenB.N. MurphyE.A. CarsonJ.A. The impact of immune cells on the skeletal muscle microenvironment during cancer cachexia.Front. Physiol.202011103710.3389/fphys.2020.0103732982782
     [Google Scholar]
  38. HuL. ZhuM. ShenY. ZhongZ. WuB. The prognostic value of intratumoral and peritumoral tumor-infiltrating FoxP3+Treg cells in of pancreatic adenocarcinoma: A meta-analysis.World J. Surg. Oncol.202119130010.1186/s12957‑021‑02420‑134654443
     [Google Scholar]
  39. ZhouQ. DongJ. SunQ. LuN. PanY. HanX. Role of neutrophil-to-lymphocyte ratio as a prognostic biomarker in patients with breast cancer receiving neoadjuvant chemotherapy: A meta-analysis.BMJ Open2021119e04795710.1136/bmjopen‑2020‑04795734561257
     [Google Scholar]
  40. MjaessG. ChebelR. KaramA. MoussaI. PretotD. Abi TayehG. SarkisJ. SemaanA. PeltierA. AounF. AlbisinniS. RoumeguèreT. Prognostic role of neutrophil-to-lymphocyte ratio (NLR) in urological tumors: An umbrella review of evidence from systematic reviews and meta-analyses.Acta Oncol.202160670471310.1080/0284186X.2021.188632333586577
     [Google Scholar]
  41. LiL.H. ChenC.T. ChangY.C. ChenY.J. LeeI.H. HowC.K. Prognostic role of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune inflammation index in acute ischemic stroke.Medicine202110025e2635410.1097/MD.000000000002635434160404
     [Google Scholar]
  42. GuptaV. ChaudhariV. ShrikhandeS.V. BhandareM.S. Does preoperative serum neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) predict prognosis following radical surgery for pancreatic adenocarcinomas? Results of a retrospective study.J. Gastrointest. Cancer202253364164810.1007/s12029‑021‑00683‑134406625
     [Google Scholar]
  43. JamiesonN.B. DenleyS.M. LogueJ. MacKenzieD.J. FoulisA.K. DicksonE.J. ImrieC.W. CarterR. McKayC.J. McMillanD.C. A prospective comparison of the prognostic value of tumor- and patient-related factors in patients undergoing potentially curative surgery for pancreatic ductal adenocarcinoma.Ann. Surg. Oncol.20111882318232810.1245/s10434‑011‑1560‑321267785
     [Google Scholar]
  44. ErmiahE. EddfairM. AbdulrahmanO. ElfagiehM. JebrielA. Al-SharifM. AssidiM. BuhmeidaA. Prognostic value of serum CEA and CA19‑9 levels in pancreatic ductal adenocarcinoma.Mol. Clin. Oncol.202217212610.3892/mco.2022.255935832472
     [Google Scholar]
/content/journals/cmir/10.2174/0115734056356822250205174104
Loading
Impact of CT-relevant Skeletal Muscle Parameters on Post-chemotherapy Survival in Patients with Unresectable Pancreatic Ductal Adenocarcinoma
Curr. Med. Imaging 21, E15734056356822 (2025); https://doi.org/10.2174/0115734056356822250205174104
/content/journals/cmir/10.2174/0115734056356822250205174104
/content/journals/cmir/10.2174/0115734056356822250205174104
Loading

Data & Media loading...


  • Article Type:     Research Article
Keyword(s): Chemotherapy; CT; Myosteatosis; Pancreatic adenocarcinoma; Sarcopenia; Survival

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test