Preoperative skeletal muscle fat infiltration is a strong predictor of poorer survival in gallbladder cancer underwent surgery

Postoperative Changes in Body Composition Predict Long-Term Prognosis in Patients with Gastric Cancer

BACKGROUND

Postoperative changes in body composition (BC) have not been clearly defined. The aim of this study was to clarify the impact of postoperative comprehensive changes in BC on long-term prognosis in gastric cancer (GC) patients.

METHODS

A total of 366 GC patients who underwent radical gastrectomy were included. Postoperative changes in skeletal muscle volume, body fat volume, and skeletal muscle density were investigated at six months postoperatively using computed tomography and evaluated their association with long-term survival.

RESULTS

Patients with decreased muscle volume, decreased fat volume, and increased muscle density had a poor prognosis, respectively. When the risk scores based on these three BC parameters were applied, patients were classified from score 0 to 4, with survival rate declining as the scores improved: score 0, interim 5-year overall survival 94%; score 1, 82%; score 2, 73%; score 3, 56%; and score 4, 20%. BC change (score > 2) was an independent poor prognosticator (HR, 3.086; p < 0.001). Preoperative myosteatosis, high Charlson comorbidity, and total gastrectomy were identified as significant independent risk factors for BC change.

CONCLUSIONS

Each of postoperative skeletal muscle loss, body fat loss, and muscle hyperdensity negatively affected prognosis of GC patients after surgery, and the BC risk scoring assessment well predicted the prognosis of postoperative patients with GC.

The impact of the muscle mass-to-fat ratio on the prognosis of patients undergoing pancreaticoduodenectomy for pancreatic cancer

To evaluate the relationship between the muscle mass-to-fat ratio (MMFR) at the third lumbar spine (L3) and overall survival (OS) as well as related complications after pancreaticoduodenectomy (PD) for pancreatic cancer. Patients who underwent PD for pancreatic cancer between March 2017 and May 2023 at the Second Affiliated Hospital of Soochow University were included. Muscle mass and fat content at the L3 were measured by computed tomography. The specific formula that was used to calculate the MMFR was total abdominal muscle area/(subcutaneous adipose tissue area + visceral adipose tissue area), and the optimal cutoff values of the MMFR based on receiver operating characteristic curves were 0.688 for males and 0.382 for females. Patient characteristics were collected, and multivariate analyses were used to evaluate the impact of the MMFR on prognosis. Kaplan-Meier survival curves and log-rank tests were used to compare OS between the high-MMFR and low-MMFR groups. On the basis of the optimal cutoff values, 191 patients were divided into two groups, with 91 patients in the low-MMFR group and 100 patients in the high-MMFR group. The incidence of POPF was significantly greater in the low-MMFR group than in the high-MMFR group. According to multivariate analysis, the MMFR was an independent factor associated with POPF and OS. Patients with low MMFRs had significantly shorter OS and a greater POPF incidence than did those with high MMFRs. The MMFR is an independent predictor of POPF and affects the OS of patients undergoing PD for pancreatic cancer.

Impact of imaging-diagnosed sarcopenia on outcomes in patients with biliary tract cancer after surgical resection: a systematic review and meta-analysis

BACKGROUND AND AIMS

Sarcopenia has been associated with poor prognosis in patients with malignant tumors. However, its impact on the outcomes of patients with biliary tract cancer (BTC) undergoing surgical resection remains unclear and warrants further review. This study aims to summarize the available evidence on this issue.

METHODS

A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library for eligible studies up to March 10, 2024. We extracted data on overall survival (OS), recurrence free survival (RFS), and postoperative major complications from the included studies as the outcomes of interest. Following data synthesis and analysis, we assessed the heterogeneity and performed subgroup analyses. Additionally, the potential for publication bias was evaluated.

RESULTS

A total of 26 studies involving 4292 BTC patients were ultimately retrieved. The findings indicated that sarcopenia was significantly associated with reduced OS in BTC patients after surgery (adjusted HR: 2.03, 95% CI: 1.65-2.48, P < 0.001, I2 = 57.4%). Moreover, sarcopenia may also be linked to poorer RFS (adjusted HR: 2.15, 95% CI: 1.79-2.59, P < 0.001, I2 = 0%) and increased postoperative major complications (OR: 1.22, 95% CI 1.02-1.47, P = 0.033, I2 = 29.2%) as well. Notably, no significant publication bias was detected through funnel plots and Egger's tests.

CONCLUSION

Sarcopenia is associated with poorer OS in BTC patients following surgery. Additionally, it may serve as a prognostic indicator for poorer RFS and increased postoperative major complications. Further studies are warrant to standardize existing definitions and validate these findings.

Prognostic factors for resected cases with gallbladder carcinoma: a systematic review and meta-analysis

OBJECTIVE

Current meta-analysis was performed to systematically evaluate the potential prognostic factors for overall survival among resected cases with gallbladder carcinoma.

METHODS

PubMed, EMBASE, and the Cochrane Library were systematically retrieved and hazard ratio (HR) and its 95% confidence interval were directly extracted from the original study or roughly estimated via Tierney's method. Standard Parmar modifications were used to determine pooled HRs.

RESULTS

A total of 36 studies with 11 502 cases were identified. Pooled results of univariate analyses indicated that advanced age (HR=1.02, P =0.00020), concurrent gallstone disease (HR=1.22, P =0.00200), elevated preoperative CA199 level (HR=1.93, P <0.00001), advanced T stage (HR=3.09, P <0.00001), lymph node metastasis (HR=2.78, P <0.00001), peri-neural invasion (HR=2.20, P <0.00001), lymph-vascular invasion (HR=2.37, P <0.00001), vascular invasion (HR=2.28, P <0.00001), poorly differentiated tumor (HR=3.22, P <0.00001), hepatic side tumor (HR=1.85, P <0.00001), proximal tumor (neck/cystic duct) (HR=1.78, P <0.00001), combined bile duct resection (HR=1.45, P <0.00001), and positive surgical margin (HR=2.90, P <0.00001) were well-established prognostic factors. Pathological subtypes ( P =0.53000) and postoperative adjuvant chemotherapy ( P =0.70000) were not prognostic factors. Pooled results of multivariate analyses indicated that age, gallstone disease, preoperative CA199, T stage, lymph node metastasis, peri-neural invasion, lymph-vascular invasion, tumor differentiation status, tumor location (peritoneal side vs hepatic side), surgical margin, combined bile duct resection, and postoperative adjuvant chemotherapy were independent prognostic factors.

CONCLUSION

Various prognostic factors have been identified beyond the 8th AJCC staging system. By incorporating these factors into a prognostic model, a more individualized prognostication and treatment regime would be developed. Upcoming multinational studies are required for the further refine and validation.

High intramuscular adipose tissue content associated with prognosis and postoperative complications of cancers

Sarcopenia has been considered an adverse prognostic factor in cancer patients. Intramuscular adipose tissue content, as a new marker of sarcopenia, can effectively reflect skeletal muscle quality. The aim of this study was performed to evaluate the association between high intramuscular adipose tissue content (IMAC) and survival outcomes and postoperative complications in cancer patients. Specific databases, including the Web of Science, Embase and Web of Science, were systematically searched to identify relevant articles evaluating the prognostic value of IMAC in cancer patients. Hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were utilized for comprehensive analysis. All data analyses were performed using STATA 12.0 software. A total of 25 studies from 24 articles including 5663 patients were enrolled in the study. Meta-analysis showed that high IMAC was associated with unfavourable overall survival (OS) (HR: 2.21, 95% CI: 1.70-2.86, P < 0.001), relapse-free survival (RFS) (HR: 1.51, 95% CI: 1.30-1.75, P < 0.001) and disease-specific survival (DSS) (HR: 1.64, 95% CI: 1.19-2.28, P = 0.003). Subgroup analysis revealed that high IMAC remained an adverse prognostic factor when stratified by different country, treatment methods, cancer type or analysis type. High IMAC had better predictive value for gallbladder carcinoma (GBC) (HR: 3.50, 95% CI: 1.98-6.17, P < 0.001), hepatocellular carcinoma (HCC) (HR: 1.84, 95% CI: 1.45-2.33, P < 0.001), pancreatic cancer (PC) (HR: 2.11, 95% CI: 1.67-2.66, P < 0.001) and colorectal cancer (CRC) (HR: 2.54, 95% CI: 1.27-5.10, P = 0.009). High IMAC was also identified as a significant risk factor for postoperative complications (OR: 2.05, 95% CI: 1.22-3.46, P = 0.007). High IMAC was associated with an adverse prognosis and an increased risk of postoperative complications in cancer patients. IMAC may be a good indicator of sarcopenia.