Independent effect of fat-to-muscle mass ratio at bioimpedance analysis on long-term survival in patients receiving surgery for pancreatic cancer

Marta Sandini; Salvatore Paiella; Marco Cereda; Marco Angrisani; Giovanni Capretti; Simone Famularo; Alessandro Giani; Linda Roccamatisi; Andrea Fontani; Giuseppe Malleo; Roberto Salvia; Franco Roviello; Alessandro Zerbi; Claudio Bassi; Luca Gianotti

doi:10.3389/fnut.2023.1118616

Independent effect of fat-to-muscle mass ratio at bioimpedance analysis on long-term survival in patients receiving surgery for pancreatic cancer

Front Nutr. 2023 Jun 13:10:1118616. doi: 10.3389/fnut.2023.1118616. eCollection 2023.

Authors

Affiliations

¹ Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy.
² General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
³ Department of Surgery, San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
⁴ Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, Rome, Italy.
⁵ Pancreatic Surgery Unit, Department of Biomedical Sciences, Humanitas Clinical and Research Center-IRCCS Rozzano, Humanitas University, Milan, Italy.
⁶ Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy.

Abstract

Introduction: Malnutrition and alteration of body composition are early features in pancreatic cancer and appear to be predictors of advanced stages and dismal overall survival. Whether specific patient characteristics measured at the preoperative bioimpedance analysis (BIA) could be associated with long-term outcomes following curative resection has not been yet described.

Methods: In a prospective multicenter study, all histologically proven resected pancreatic cancer patients were included in the analysis. BIA was measured for all patients on the day before surgery. Demographics, perioperative data, and postoperative outcomes were prospectively collected. Patients who experienced 90-day mortality were excluded from the analysis. Survival data were obtained through follow-up visits and phone interviews. Bioimpedance variables were analyzed according to the overall survival using the Kaplan-Meier curves and the univariate and multivariate Cox regression model.

Results: Overall, 161 pancreatic cancer patients were included. The median age was 66 (60-74) years, and 27.3% received systemic neoadjuvant treatment. There were 23 (14.3%) patients malnourished in the preoperative evaluation. Median OS was 34.0 (25.7-42.3) months. Several bioimpedance variables were associated with OS at the univariate analysis, namely the phase angle [HR 0.85, 95% CI 0.74-0.98)], standardized phase angle [HR 0.91, 95% CI 0.82-0.99)], and an increased ratio between the fat and lean mass (FM/FFM) [HR 4.27, 95% CI 1.10-16.64)]. At the multivariate analysis, the FM/FFM ratio was a confirmed independent predictor of OS following radical resection, together with a positive lymph nodal status.

Conclusion: Alteration of body composition at the preoperative bioimpedance vector analysis (BIVA) can predict dismal oncologic outcomes following pancreatic resection for cancer.

Keywords: bioimpedance analysis; body composition; outcomes; pancreatic cancer; surgical oncology.