Myosteatosis and Visceral Adiposity on Preoperative CT are Associated with Early Recurrence in Patients with Resectable Pancreatic Ductal Adenocarcinoma.

RATIONALE AND

OBJECTIVES

Evidence suggests that body composition is a predictor of poor prognosis in pancreatic ductal adenocarcinoma (PDAC), but its association with early recurrence remains undetermined. This study investigated whether body composition parameters were associated with early recurrence after surgery in patients with resectable PDAC.

MATERIALS AND

METHODS

A total of 451 patients (376 in the training cohort, 75 in the external validation cohort) from two centers were retrospectively analyzed. Body composition parameters included skeletal muscle index (SMI) and density (SMD), subcutaneous and visceral adipose tissue (SAT and VAT) area and density. Cox proportional hazards regression was used to identify independent prognostic factors of early recurrence, and a weighted scoring system was developed and externally validated.

RESULTS

Multivariable analysis revealed that concomitant pancreatitis (HR:1.51, 95%CI:[1.02-2.24],P=0.041), peripancreatic infiltration (HR:1.70, 95%CI:[1.25-2.28], P<0.001), tumor grade (III vs. I-II) (HR:1.75, 95%CI:[1.33-2.29], P<0.001), adjuvant chemotherapy/concurrent chemoradiotherapy (CCRT) (HR:0.63, 95%CI:[0.47-0.86], P=0.003), CA19-9>500 U/mL (HR:2.03, 95%CI:[1.49-2.61], P<0.001), and myosteatosis (HR:1.65, 95%CI:[1.26-2.18], P<0.001) and high VAT (HR:1.48, 95%CI:[1.09-2.01], P=0.022) were independent prognostic factors for early recurrence. The scoring system demonstrated moderate to good discrimination in the training cohort (AUC=0.724, 95% CI:0.677-0.768) and external validation cohort (AUC=0.708, 95%CI: 0.591-0.807). Patients with scores ≥2.5 had significantly higher early recurrence rates (76% vs. 43%; P<0.001). SMD was correlated with apolipoprotein A1, albumin and neutrophil-to-lymphocyte ratio (NLR) (all P<0.010). Baseline NLR was independently associated with SMD reduction (P<0.001) in the availability-based subgroup with 6-month postoperative CT (n = 129).

CONCLUSION

Myosteatosis and high VAT were independently associated with early recurrence after surgery. Incorporating body composition analysis into postoperative assessments may improve risk stratification for early recurrence.