Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Prognostic Value of Sarcopenia and Myosteatosis in Patients with Resectable Pancreatic Ductal Adenocarcinoma

  • Dong Wook Kim (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Hyemin Ahn (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kyung Won Kim (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Seung Soo Lee (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Hwa Jung Kim (Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Yousun Ko (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Taeyong Park (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jeongjin Lee (School of Computer Science and Engineering, Soongsil University)
  • Received : 2022.04.25
  • Accepted : 2022.07.21
  • Published : 2022.11.01
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Abstract

Objective: The clinical relevance of myosteatosis has not been well evaluated in patients with pancreatic ductal adenocarcinoma (PDAC), although sarcopenia has been extensively researched. Therefore, we evaluated the prognostic value of muscle quality, including myosteatosis, in patients with resectable PDAC treated surgically. Materials and Methods: We retrospectively evaluated 347 patients with resectable PDAC who underwent curative surgery (mean age ± standard deviation, 63.6 ± 9.6 years; 202 male). Automatic muscle segmentation was performed on preoperative computed tomography (CT) images using an artificial intelligence program. A single axial image of the portal phase at the inferior endplate level of the L3 vertebra was used for analysis in each patient. Sarcopenia was evaluated using the skeletal muscle index, calculated as the skeletal muscle area (SMA) divided by the height squared. The mean SMA attenuation was used to evaluate myosteatosis. Diagnostic cutoff values for sarcopenia and myosteatosis were devised using the Contal and O'Quigley methods, and patients were classified according to normal (nMT), sarcopenic (sMT), myosteatotic (mMT), or combined (cMT) muscle quality types. Multivariable Cox regression analyses were conducted to assess the effects of muscle type on the overall survival (OS) and recurrence-free survival (RFS) after surgery. Results: Eighty-four (24.2%), 73 (21.0%), 75 (21.6%), and 115 (33.1%) patients were classified as having nMT, sMT, mMT, and cMT, respectively. Compared to nMT, mMT and cMT were significantly associated with poorer OS, with hazard ratios (HRs) of 1.49 (95% confidence interval, 1.00-2.22) and 1.68 (1.16-2.43), respectively, while sMT was not (HR of 1.40 [0.94-2.10]). Only mMT was significantly associated with poorer RFS, with an HR of 1.59 (1.07-2.35), while sMT and cMT were not. Conclusion: Myosteatosis was associated with poor OS and RFS in patients with resectable PDAC who underwent curative surgery.

Keywords

Acknowledgement

This study was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI18C1216).

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