Abstract
Rationale: Pancreatic cancer related cachexia and skeletal muscle wasting is related to poor outcome. Body muscle mass can be assessed by CT-imaging. Intermuscular adipose tissue and/or intermyofibrillar fat accumulation (reflected by the “radiation attenuation”) are increased in cancer patients independent of sarcopenia, and might be indicators of muscle loss and muscle quality. This study aimed to assess the impact of fat accumulation in muscle on postoperative outcome in surgical patients with pancreatic cancer. Methods: A prospective cohort of 192 pancreatic cancer patients operated between 2008 2013 was analysed by CTimage analysis at the L3 level to measure cross-sectional surface area of (1) skeletal muscle, (2) intermuscular adipose tissue, (3) visceral adipose tissue; the mean muscle radiation attenuation, reflecting intermyofibrillar fat, was defined by the average muscle radiation attenuation in Hounsfield units. Results: Low muscle radiation attenuation, indicating high intermyofibrillar fat, was associated with low survival compared with middle and high muscle attenuation (median survival 46.5, 77.1, and 67.1 weeks, respectively; p < 0.001) and was associated with an increased risk of major complications (OR: 2.3, 95%CI: 1.4 5.6). Muscle attenuation index was negatively correlated with intermuscular adipose tissue (rp = 0.68, p < 0.001). Increased visceral adipose tissue was associated with development of pancreatic fistula (OR: 2.5, 95%CI: 1.1 6.1) and post-operative infections (OR: 2.7, 95%CI: 1.4 5.2). Conclusion: A reduced muscle radiation attenuation is associated with reduced survival and increased severe postoperative complications. The strong correlation between intermyofibrillar fat and intermuscular adipose tissue suggests a common mechanism of origin, warranting further investigation. Preoperative CT-image analysis of body tissue compartments likely is clinically useful to identify high-risk patients.
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