High Systemic Immune Inflammation Index Is Associated With Low Skeletal Muscle Quantity in Resectable Pancreatic Ductal Adenocarcinoma

Mohammad Hosein Aziz; Jelle C van Dongen; Lawlaw Saida; Mustafa Suker; Jeroen L A van Vugt; Yordi van Putten; Kostandinos Sideras; Jesse V Groen; J Sven D Mieog; Claudia J Lucassen; Anneke Droop; Katya Mauff; Shirin Shahbazi Feshtali; Bas Groot Koerkamp; Dana A M Mustafa; Casper J van Eijck

doi:10.3389/fonc.2022.827755

High Systemic Immune Inflammation Index Is Associated With Low Skeletal Muscle Quantity in Resectable Pancreatic Ductal Adenocarcinoma

Front Oncol. 2022 Feb 28:12:827755. doi: 10.3389/fonc.2022.827755. eCollection 2022.

Authors

Mohammad Hosein Aziz¹, Jelle C van Dongen¹, Lawlaw Saida², Mustafa Suker¹, Jeroen L A van Vugt¹, Yordi van Putten¹, Kostandinos Sideras³, Jesse V Groen⁴, J Sven D Mieog⁴, Claudia J Lucassen⁵, Anneke Droop⁵, Katya Mauff⁶, Shirin Shahbazi Feshtali⁷, Bas Groot Koerkamp¹, Dana A M Mustafa², Casper J van Eijck^{1

2}

Affiliations

¹ Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
² Department of Pathology, The Tumor Immuno-Pathology Laboratory, Erasmus, University Medical Center, Rotterdam, Netherlands.
³ Divisions of Medical Oncology and Hematology, Mayo Clinic, Rochester, MN, United States.
⁴ Department of Surgery, Leiden University Medical Center, Leiden, Netherlands.
⁵ Department of Dietetics, Leiden University Medical Center, Leiden, Netherlands.
⁶ Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, Netherlands.
⁷ Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.

Abstract

Background and aims: Failing immune surveillance in pancreatic ductal adenocarcinoma (PDAC) is related to poor prognosis. PDAC is also characterized by its substantial alterations to patients' body composition. Therefore, we investigated associations between the host systemic immune inflammation response and body composition in patients with resected PDAC.

Methods: Patients who underwent a pancreatectomy for PDAC between 2004 and 2016 in two tertiary referral centers were included. Skeletal muscle mass quantity and muscle attenuation, as well as subcutaneous and visceral adipose tissue at the time of diagnosis, were determined by CT imaging measured transversely at the third lumbar vertebra level. Baseline clinicopathological characteristics, laboratory values including the systemic immune inflammation index (SIII), postoperative, and survival outcomes were collected.

Results: A total of 415 patients were included, and low skeletal muscle mass quantity was found in 273 (65.7%) patients. Of the body composition indices, only low skeletal muscle mass quantity was independently associated with a high (≥900) SIII (OR 7.37, 95% CI 2.31-23.5, p=0.001). The SIII was independently associated with disease-free survival (HR 1.86, 95% CI 1.12-3.04), and cancer-specific survival (HR 2.21, 95% CI 1.33-3.67). None of the body composition indices were associated with survival outcomes.

Conclusion: This study showed a strong association between preoperative low skeletal muscle mass quantity and elevated host systemic immune inflammation in patients with resected PDAC. Understanding how systemic inflammation may contribute to changes in body composition or whether reversing these changes may affect the host systemic immune inflammation response could expose new therapeutic possibilities for improving patients' survival outcomes.

Keywords: body composition; pancreatic ductal adenocarcinoma; skeletal muscle mass; survival; systemic immune inflammation index.