The role of sarcopenia in patients with intrahepatic cholangiocarcinoma: Prognostic marker or hyped parameter?

Sarcopenia has emerged as a prognostic parameter in numerous cancer entities. Current research favours its role as a determining factor for overall survival (OS) in patients with intrahepatic cholangiocarcinoma (ICC); however, it is unclear whether sarcopenia is a truly independent survival predictor if combined with established prognostic factors. Between 1997-2018, 417 patients with histopathologically confirmed ICC were referred to our centre, of whom 293 were included in this study. Cross-sectional imaging, laboratory examinations and histopathological reports were retrospectively analysed. Psoas muscle index (PMI) as easy-to-measure marker of sarcopenia was calculated. Using optimal stratification, sex-specific PMI cut-offs were calculated and tested in hazard regression models against previously published risk factors-for the entire cohort, and within resected and non-resected subgroups. Median OS for patients with low respectively high PMI was 23.5 and 34.5 months in the resected subgroup (P = 0.008) and 5.1 and 7.8 months (P = 0.01) in the non-resected subgroup. In multivariate hazard regression models for the entire cohort, low PMI exhibited independent predictive value (P = 0.01) as did translobar tumour spread (P = 0.005), extrahepatic extension (P = 0.03), tumour boundary type (P < 0.001), carbohydrate antigen 19-9 (CA 19-9) levels (P = 0.001), alkaline phosphatase levels (P = 0.001) and distant metastasis (P < 0.001). In subgroup analyses, low PMI remained predictive among non-resected patients (P = 0.03), but lost its predictive value among resected patients (P = 0.15). Psoas muscle index strongly predicted OS in univariate analysis. However, addition of established risk factors eliminated its predictive value among resected patients. Thus, when resection is deemed oncologically reasonable, patients should not be excluded from surgery because of sarcopenia alone.

Hahn F ，Müller L ，Stöhr F ，Mähringer-Kunz A ，Schotten S ，Düber C ，Bartsch F ，Lang H ，Galle PR ，Weinmann A ，Kloeckner R ... -  《-》

Pre-operative Sarcopenia Identifies Patients at Risk for Poor Survival After Resection of Biliary Tract Cancers.

Chakedis J ，Spolverato G ，Beal EW ，Woelfel I ，Bagante F ，Merath K ，Sun SH ，Chafitz A ，Galo J ，Dillhoff M ，Cloyd J ，Pawlik TM ... -  《-》

Skeletal muscle mass predicts the prognosis of patients with intrahepatic cholangiocarcinoma.

We studied the prognostic impact of sarcopenia after hepatic resection for intrahepatic cholangiocarcinoma (ICC). Sixty-one patients who underwent surgery for ICC during 2000-2017 were analyzed retrospectively. Psoas muscle areas were measured on CT scans at the third lumbar vertebra. Areas less than the sex-specific median were deemed low skeletal muscle masses (SMMs). Low-SMM patients were significantly more often older (p = 0.002) than high-SMM patients, had lower serum albumin (p = 0.004), higher serum C-reactive protein (CRP) (p = 0.002), and higher carbohydrate antigen 19-9 (p < 0.001). Five-year overall survival rates were 72.5% and 17.6% and 5-year recurrence-free survival rates were 58.6% and 21.1%, respectively, in high- and low-SMM patients. Multivariable analysis revealed that low SMM predicted unfavorable prognoses. SMM was associated with immune nutritional status (e.g., prognostic nutritional index, Glasgow prognostic score, CRP/albumin ratio). Low SMM was related to worse surgical outcomes in patients with ICC following hepatic resection.

Yugawa K ，Itoh S ，Kurihara T ，Yoshiya S ，Mano Y ，Takeishi K ，Harada N ，Ikegami T ，Soejima Y ，Mori M ，Yoshizumi T ... -  《-》

The prognostic value of sarcopenia combined with hepatolithiasis in intrahepatic cholangiocarcinoma patients after surgery: A prospective cohort study.

Intrahepatic Cholangiocarcinoma (ICC) is the second most common primary liver cancer with dismal survival rates. This study aimed to explore the prognostic value of sarcopenia combine with hepatolithiasis in surgically treated ICC patients and develop a prognostic nomogram to help make clinical decisions. A prospective cohort study was conducted including patients who underwent hepatectomy for ICC between August 2012 and October 2019. The association between the sarcopenia combined with hepatolithiasis and survival, including overall survival (OS) and recurrence-free survival (RFS) was investigated using the Kaplan-Meier (K-M) method. Univariable and multivariable Cox regression analysis was performed to determine the independent prognostic factors and a nomogram establishment was undertaken based on the multivariable analysis. A total of 121 ICC patients were included in the study. K-M analysis revealed that ICC patients with sarcopenia and hepatolithiasis have worse OS and RFS than those without sarcopenias and/or hepatolithiasis (p < 0.01). Multivariable analysis showed that age, serum CEA, hepatolithiasis, sarcopenia and diabetes were independent prognostic factors for OS(p < 0.05). Finally, a nomogram with good performance in survival prediction was established (C-index was 0.721; the area under the curve of OS was 0.837). The stratified analysis based on the nomogram disclosed that the median OS was 11.9 months in high-risk patients and 51.2 months in low-risk patients (p < 0.001). ICC patients with sarcopenia and hepatolithiasis have worse OS and RFS. The nomogram we developed is a practical tool that can provide a more individualized risk assessment for surgically treated ICC patients.

Deng L ，Wang Y ，Zhao J ，Tong Y ，Zhang S ，Jin C ，Chen K ，Bao W ，Yu Z ，Chen G ... -  《-》

Effect of sarcopenia on the outcomes after pancreaticoduodenectomy for distal cholangiocarcinoma.

The relationship between sarcopenia and patient outcomes after pancreaticoduodenectomy (PD) for distal cholangiocarcinoma (DCC) remains unclear. We assessed the impact of sarcopenia on the outcomes after PD for DCC. We retrospectively analysed 65 patients who underwent PD for DCC. The quality of skeletal muscle indicated by the psoas muscle mass index (PMI) were measured on pre-operative computed tomography images. The impact of pre-operative sarcopenia on short- and long-term outcomes was evaluated. Regarding short-term surgical outcomes, there were no marked differences between the high and low PMI groups. Regarding long-term oncological outcomes, the rates of recurrence (23.5% versus 58.3%, P = 0.011) was significantly lower in the high PMI group than in the low PMI group. Furthermore, the recurrence-free survival and disease-specific survival were longer in the high PMI group (P = 0.023 and P = 0.043, respectively). On multivariate analyses, low PMI was an independent predictor of recurrence (hazard ratio (HR) 11.06; P = 0.022) and disease-specific death (HR 11.88; P = 0.043). Our findings suggested an association between pre-operative sarcopenia and poor long-term oncological outcomes after PD for DCC.

Umetsu S ，Wakiya T ，Ishido K ，Kudo D ，Kimura N ，Miura T ，Toyoki Y ，Hakamada K ... -  《-》