Abstract
Aims: Pancreatic cancer related cachexia and muscle wasting are associated with poor outcome. Body muscle mass can be assessed by CT-imaging. Intermuscular adipose tissue and intermyofibrillar fat accumulation (reflected by the ‘muscle attenuation index’) 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 pancreatic cancer patients operated between 2008–2013 was analysed by CT-image analysis at the L3 level to measure cross-sectional surface area of 1) skeletal muscle, 2) intermuscular adipose tissue, and 3) visceral adipose tissue; the muscle attenuation index, reflecting intermyofibrillar fat, was defined by the average muscle signal intensity in Hounsfield units. Results: Low muscle attenuation index, indicating high intermyofibrillar fat, was associated with low survival compared with middle and high muscle attenuation index (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 related to an increased risk of 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). Conclusions: A low muscle attenuation index 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 may prove to be clinically useful in identifying patients with an increased risk of complications.
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