Clin Endosc.  2024 Jan;57(1):112-121. 10.5946/ce.2022.278.

Impact of sarcopenia on biliary drainage during neoadjuvant therapy for pancreatic cancer

• Kataoka K
• Ohno E
• Ishikawa T
• Yamao K
• Mizutani Y
• Iida T
• Takami H
• Maeda O
• Yamaguchi J
• Yokoyama Y
• Ebata T
• Kodera Y
• Kawashima H

• KMID: 2551200
• DOI: http://doi.org/10.5946/ce.2022.278

Abstract

Background/Aims
Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer has been demonstrated, recurrent biliary obstruction (RBO) in patients with pancreatic cancer with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting.
Methods
Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival, time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO.
Results
A few significant differences were observed in patient characteristics, overall survival, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148–28.381; p=0.033).
Conclusions
Sarcopenia was identified as an independent risk factor for RBO in patients with pancreatic cancer with FCSEMS during NAT.

Keyword

Fully covered self-expandable metal stents; Neoadjuvant therapy; Pancreatic cancer; Recurrent biliary obstruction; Sarcopenia

Figure

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  Fig. 1. Flowchart showing the selection of the study population. FCSEMS, fully covered self-expandable metal stent; MBO, malignant biliary obstruction; PC, pancreatic cancer; NAT, neoadjuvant chemo(radiation) therapy.

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  Fig. 2. Axial computed tomography images at the third lumbar level, with skeletal muscles highlighted in green (–29 to 150 Hounsfield units) using SYNAPSE VINCENT software (Fujifilm).

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  Fig. 3. Kaplan-Meier curves of the overall survival (OS) in the normal skeletal muscle index (SMI) group (solid line) and low SMI group (dotted line). Median OS was 689 days in the normal SMI group and 1,059 days in the low SMI group, with no significant difference between the two groups (the log-rank test, p=0.701).

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  Fig. 4. Kaplan-Meier curves of the time to recurrent biliary obstruction (TRBO) in the normal skeletal muscle index (SMI) group (solid line) and low SMI group (dotted line). Median TRBO was not reached in the normal SMI group and was 112 days in the low SMI patients, which was significantly longer in the normal SMI group than in the low SMI group (the log-rank test, p=0.004).

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