Sarcopenia Predicts Cancer Mortality in Male but Not in Female Patients Undergoing Surgery for Cholangiocellular Carcinoma

Markus Sebastian Jördens; Lisa Heinrichs; Sven H Loosen; Linda Wittig; Verena Keitel; David Schöler; Maximilian Schulze-Hagen; Christina Loberg; Gerald Antoch; Wolfram Trudo Knoefel; Tom Luedde; Georg Fluegen; Christoph Roderburg

doi:10.3390/cancers13215359

Sarcopenia Predicts Cancer Mortality in Male but Not in Female Patients Undergoing Surgery for Cholangiocellular Carcinoma

Cancers (Basel). 2021 Oct 26;13(21):5359. doi: 10.3390/cancers13215359.

Affiliations

¹ Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany.
² Department for Diagnostic and Interventional Radiology, University Hospital Aachen, 52074 Aachen, Germany.
³ Institute for Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany.
⁴ Department of General, Visceral and Pediatric Surgery, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany.

Abstract

Introduction: Surgery represents the only curative treatment option for patients with cholangiocarcinoma. However, complete tumor resection requires extensive surgery in many patients, and it is still debated which patients represent the ideal candidates for such therapy in terms of overall survival. Sarcopenia has been associated with an adverse outcome for various malignancies, but its role in the context of patients undergoing tumor resection for cholangiocellular adenocarcinoma (CCA) is only poorly understood. Here, we evaluated the role of sarcopenia in the outcome of CCA patients undergoing radical tumor resection.

Methods: Pre-operative CT scans were used to assess the skeletal muscle index (L3SMI) as well as the psoas muscle index (L3PMI) in n = 76 patients receiving curative intended surgery for CCA. L3SMI and L3PMI were correlated with clinical and laboratory markers.

Results: Patients with a skeletal muscle index or psoas muscle index above an established ideal cut-off (54.26 and 1.685 cm²/m²) showed a significantly better overall survival in Kaplan-Meier Curve analyses (L3SMI: 1814 days (95% CI: 520-3108) vs. 467 days (95% CI: 225-709) days; log rank X²(1) = 7.18, p = 0.007; L3PMI: 608 days (95% CI: 297-919) vs. 87 days (95% CI: 33-141), log rank X²(1) = 18.71; p < 0.001). Notably, these findings, especially for L3PMI, were confirmed in univariate (L3SMI: HR 0.962 (0.936-0.989); p = 0.006; L3PMI: HR 0.529 (0.366-0.766); p ≤ 0.001) and multivariate Cox regression analyses. Further analyses revealed that the prognostic value of both L3SMI and L3PMI was restricted to male patients, while in female patients survival was independent of the individual muscle mass.

Conclusion: Measurement of muscle mass from preoperative CT scans represents an easily obtainable tool to estimate patient prognosis following curative surgery. The prognostic value was restricted to male patients, while in female patients these parameters did not reflect the patient outcome.

Keywords: CCA; cholangiocellular adenocarcinoma; prognostic marker; sarcopenia; surgery.