Effect of body fat mass loss on prognosis of radical resection for pancreatic ductal adenocarcinoma based on bioelectrical impedance analysis

doi:10.21203/rs.3.rs-3241486/v1

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Research Article

Effect of body fat mass loss on prognosis of radical resection for pancreatic ductal adenocarcinoma based on bioelectrical impedance analysis

https://doi.org/10.21203/rs.3.rs-3241486/v1

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published 11 Jan, 2024

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Background

Few reports have performed a prognostic analysis based on bioelectrical impedance analysis in patients with radical resection of pancreatic ductal adenocarcinoma (PDAC), and its usefulness in prognostic analysis remains unclear. This study aimed to evaluate body composition changes in patients undergoing radical resection for PDAC and analyze its impact on prognosis.

Methods

The medical records of radical resection for patients with PDAC were retrospectively reviewed, and the parameters of body composition, including body weight, skeletal muscle mass, body fat mass (BFM), and extracellular water-total body water ratio, from preoperatively to 12 months postoperatively, for each surgical procedure were measured based on direct segmental multifrequency bioelectrical impedance analysis with an InBody 770 (InBody Inc., Tokyo, Japan) device. The clinicopathological and prognostic factors were analyzed.

Results

Among 79 patients who underwent radical resection for PDAC, 36 (46%), 7 (8%), and 36 (46%) underwent pancreatoduodenectomy, total pancreatectomy, and distal pancreatectomy, respectively. The multivariate overall survival analysis demonstrated that BFM loss percentage at 1 month postoperatively ≧ 14% (p = 0.021), lymph node metastasis (p = 0.014), and non-adjuvant chemotherapy (p < 0.001) were independent poor prognostic factors. Multivariate analysis revealed that preoperative BFM < 12 kg and preoperative albumin < 3.5 g/dL were independently associated with BFM loss percentage at 1 month postoperatively ≧ 14% (p = 0.016 and p = 0.047, respectively).

Conclusions

Loss of BFM in the early postoperative period may have a poor prognosis in radical resection of PDAC.

bioelectrical impedance analysis

body composition

BFM

prognosis

pancreatic ductal adenocarcinoma

Surgical resection is the only curative treatment option for pancreatic ductal adenocarcinoma (PDAC). Additionally, multidisciplinary treatment, including neoadjuvant and adjuvant therapies, has become the standard for PDAC in recent years [1, 2]. However, even if curative resection is performed, the 5-year overall survival (OS) rate remains low at 20.7–44.1% [2–4]. Previous reports have investigated the impact of preoperative nutritional evaluation and body composition evaluation on the long-term prognosis of PDAC. Non-invasive nutritional evaluation methods that combine blood biochemical findings from assessments, such as the Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS) [5, 6], and Prognostic Nutritional Index (PNI) [7, 8], with the evaluation of the psoas major [9, 10] and general skeletal [11] muscles using abdominal computed tomography (CT) images have reported that patients with a poor preoperative nutritional status and sarcopenia may have poor long-term prognosis. In addition, poor preoperative nutritional status, sarcopenia, and visceral obesity may be associated with postoperative complications [12, 13].

Bioelectrical impedance analysis (BIA) is a widely used non-invasive method to evaluate body composition parameters, including the body weight (BW), body mass index (BMI), skeletal muscle mass (SMM), skeletal muscle mass index (SMI), body fat mass (BFM), and extracellular water-total body water ratio (ECW/TBW). However, there is a scarcity of reports showing the effect of early postoperative body composition changes assessed by BIA on the long-term prognosis of radical resection for PDAC. Therefore, this study aimed to evaluate the body composition changes in the early postoperative period following radical resection for PDAC and analyze their impact on prognosis.

Study design

We retrospectively reviewed the medical records of patients who underwent radical resection for PDAC at the Department of Surgery of the National Hospital Organization Kure Medical Center in Hiroshima, Japan, between August 2016 and July 2022. This Institutional Review Board of National Hospital Organization Kure Medical Center (2023-17) approved this study, which was conducted following the principles of the Declaration of Helsinki. In addition, all patients provided written informed consent.

Neoadjuvant therapy

In our institution, neoadjuvant therapy (NAT) has been administered to patients with resectable PDAC since 2019, as well as to those with borderline resectable (BR) or locally advanced (LA) PDAC with arterial contacts, such as the superior mesenteric, hepatic, or celiac arteries, since 2016. Previously, all patients with resectable pancreatic cancer had received surgery upfront. NAT regimens for patients with resectable PDAC included gemcitabine/S-1, while those for patients with BR/LA PDAC included gemcitabine/nab-paclitaxel/S-1, gemcitabine/nab-paclitaxel, and 5-fluorouracil/leucovorin/irinotecan/oxaliplatin. No patient received radiation therapy during the study period.

Data collection

Patient demographic and clinicopathological data for each surgical procedure included age, sex, initial carbohydrate antigen 19 − 9 (CA19-9) level, preoperative PNI, GPS, and resectability status according to the National Comprehensive Cancer Network guideline version 2 2021 [14], operating time, operative blood loss, pathological tumor size, lymph node metastasis, and adjuvant chemotherapy. Postoperative complications were defined as those with a Clavien–Dindo classification ≧ Grade Ⅲ [15]. The body composition parameters included the BW, SMM, SMI, BFM, and ECW/TBW, and were measured preoperatively and at 1, 6, and 12 months postoperatively based on direct segmental multifrequency BIA with an InBody 770 device (InBody Inc., Tokyo, Japan). The patients stood barefoot on the scale and aligned their heels with round electrodes. Thereafter, they held the hand electrode and placed their thumb on the round electrode. With the arm straight and not contacting with the body, the impedance of five body parts (i.e., right arm, left arm, trunk, right leg, and left leg) was measured at six different frequencies (1 kHz, 5 kHz, 50 kHz, 250 kHz, 500 kHz, and 1,000 kHz), while the reactance of the five body parts at three frequencies (5 kHz, 50 kHz, and 250 kHz) was also measured.

Adjuvant therapy and surveillance

Adjuvant chemotherapy was recommended to all patients and was administered to those who were tolerant and consenting after radical pancreatectomy. Regular surveillance was performed via blood testing, which included tumor markers and multidetector CT at intervals of 3–6 months. When two or more modalities, such as magnetic resonance imaging or positron emission tomography-CT, indicated a recurrence or recurrent lesion at two different time points, recurrence was confirmed and recorded. The survival time after surgery and cause of death were also recorded for the patients who died, and the OS time and recurrence status were recorded for those who survived.

Statistical analysis

Data are expressed as medians and ranges or as absolute values and percentages. The chi-square or Fisher’s exact test was used for the categorical variables, while the Wilcoxon two-sample test was used to compare continuous variables in the univariate analysis. A paired t-test with Bonferroni correction was used for body composition changes. Survival curves were obtained using the Kaplan–Meier method, and the log-rank test was used to compare distributions. The proportional hazard regression model (Cox regression) was used to perform multivariate survival analyses. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated, and cutoff values were defined by receiver operating characteristic (ROC) curve analysis for 3-year OS after surgery. Preoperative low SMI was defined as SMI < 7.0 kg/m² for male patients and SMI < 5.7 kg/m² for female patients. The cutoff PNI value was determined according to previous publications [16]. All tests were two-sided, with statistical significance set at p < 0.05. All statistical analyses were performed using JMP statistical software (version 16.0; SAS Institute, Cary, NC, USA).

Patients

A total of 79 patients underwent radical resection for PDAC. The clinicopathological characteristics of the patients for each surgical procedure are presented in Table 1. Among 79 patients who underwent radical resection for PDAC, 36 (46%), 7 (8%), and 36 (46%) underwent pancreatoduodenectomy (PD), total pancreatectomy (TP), and distal pancreatectomy (DP), respectively. Preoperative BMI and preoperative serum albumin levels were significantly lower in the PD group among the three groups (21.2, 21.5, 23.1 kg/m², respectively; p = 0.033; and 3.6, 3.9, and 3.8 g/mL, respectively; p = 0.045). Operating time and operative blood loss were significantly higher in the TP group among the three groups (499, 515, and 373 min, respectively; p <0.001; and 460, 640, and 200 mL, respectively; p <0.001).

Body composition changes

The analysis of postoperative mean body composition showed that the mean BWs in the PD group preoperatively and at 1, 6, and 12 months postoperatively were 53.8 ± 10.6, 52.1 ± 10.1, 52.1 ± 10.7 kg, and 52.0 ± 10.1 kg, respectively; the corresponding values in the TP group were 57.5 ± 9.8, 56.0 ± 10.1, 51.0 ± 8.0, and 51.0 ± 5.8 kg, respectively; and, in the DP group, these values were 57.7 ± 7.3, 55.9 ± 9.6, 54.7 ± 7.9, and 55.4 ± 7.8 kg, respectively (Figure 1a). The BWs in the PD and DP groups at 1, 6, and 12 months postoperatively significantly decreased compared to the preoperative BWs. The mean SMM values in the PD group were 21.3 ± 4.9, 21.1 ± 5.1, 21.3 ± 5.5, and 21.4 ± 5.5 kg, respectively; the corresponding values in the TP group were 21.5 ± 3.2, 21.3 ± 4.5, 21.7 ± 4.9, and 21.3 ± 4.5 kg, respectively; and, in the DP group, these values were 22.3 ± 4.4, 21.9 ± 5.0, 22.3 ± 4.7, and 22.4 ± 4.9 kg, respectively (Figure 1b). No significant difference was observed for any period. The mean BFM in the PD group was 13.7 ± 6.4, 11.7 ± 6.6, 9.5 ± 4.7 kg, and 9.6 ± 4.1 kg; the corresponding values in the TP group were 13.5 ± 3.2, 10.7 ± 7.9, 7.3 ± 2.4, and 7.9 ± 2.7 kg; and, in the DP group, these values were 16.3 ± 6.3, 14.5 ± 6.4, 12.7 ± 5.9, and 13.2 ± 5.5 kg, respectively (Figure 1c). The BFM in the PD and DP groups at 1, 6, and 12 months postoperatively significantly decreased compared to the preoperative BFM. The mean ECW/TBW in the PD group was 0.397 ± 0.009, 0.403 ± 0.010, 0.404 ± 0.012, and 0.401 ± 0.010; the corresponding values in the TP group were 0.400 ± 0.010, 0.407 ± 0.011, 0.408 ± 0.002, and 0.405 ± 0.005, respectively; and, in the DP group, these values were 0.400 ± 0.008, 0.401 ± 0.012, 0.401 ± 0.009, and 0.400 ± 0.010, respectively (Figure 1d). The ECW/TBW in the PD group at 1, 6, and 12 months postoperatively and the corresponding values in the TP group at 6 months postoperatively significantly increased compared to the preoperative ECW/TBW.

Survival analysis

The median follow-up period was 25.4 (range, 2.9–73.5) months, and the survival curve of all patients showed that the median survival time (MST) after surgery was 44.6 months (Figure 2a). The postoperative 1-, 3- and 5-year survival rates were 89%, 61%, and 42%, respectively. The median relapse-free survival (RFS) after surgery was 24.1 months (Figure 2b), and the postoperative 1-, 3- and 5-year RFS rates were 71%, 44%, and 40%, respectively. The univariate and multivariate OS analyses of the factors predictive of a poor prognosis are shown in Table 2. Univariate OS analysis of poor prognostic factors demonstrated that BFM loss percentage at 1 month postoperatively ≧14% (p = 0.021), lymph node metastasis (p = 0.030), and no-adjuvant chemotherapy (p <0.001) were significantly associated with OS. Furthermore, multivariate analysis demonstrated that BFM loss percentage 1 month after surgery ≧14% (HR, 2.52; 95% CI, 1.15–5.55; p = 0.021), lymph node metastasis (HR, 3.61; 95% CI, 1.30–10.02; p = 0.014), and no-adjuvant chemotherapy (HR, 13.30; 95% CI, 4.08–43.41; p <0.001) were independent poor prognostic factors. The survival curves of patients stratified by BFM loss percentage at 1 month postoperatively ≧14%, divided into the BFM loss group (BLG) or the normal group (NG), are shown in Figure 3. The median OS rate after surgery was significantly worse in the BLG than in the NG (38.8 vs 64.0 months, p = 0.021) (Figure 3a). The RFS postoperatively was stratified by the BLG or NG. There was no significant difference in the median RFS after surgery between the two groups (19.6 vs 43.3 months, p = 0.464) (Figure 3b). The 86% of patients in the BLG and 88% of those in the NG underwent adjuvant chemotherapy (p = 0.830). The 51% of patients in the BLG and 45% of those in the NG recurred (p = 0.587). The multivariate analysis revealed that preoperative BFM <12 kg and preoperative albumin <3.5 g/dL were independently associated with BFM loss percentage at 1 month postoperatively ≧14% (odds ratio [OR], 4.23; 95% CI, 1.31–13.73; p = 0.016 and OR, 3.11; 95% CI, 1.01–9.56; p = 0.047, respectively) (Table 3).

This study revealed that BFM loss in the early postoperative period in patients having undergone radical resection for PDAC may lead to poor prognosis based on direct segmental multifrequency BIA assessment. Currently, there are no established methods for evaluating the nutritional status and body composition in patients with PDAC; however, there have been various reports about the impact on long-term prognosis after surgery for PDAC based on blood biochemistry findings or body composition changes. Previously, Kim et al. reported that a low PNI change (-1.94) between pre- and post-neoadjuvant chemotherapy (NAC) was an independent risk factor for the OS of patients with resected PDAC following NAC. In the preoperative setting, improving the PNI can improve the long-term oncologic outcomes of PDAC [7]. Abe et al. [16] found that preoperative PNI ≧ 45 in patients undergoing surgical resection for PDAC may be associated with good prognosis. In addition, Yamada, et al. indicated that a GPS score of 2 points was a significant independent poor prognostic factor in patients that underwent pancreatic cancer resection [17]. Regarding body composition changes, many studies have used abdominal CT imaging. In previous reports, preoperative visceral adiposity and sarcopenic visceral obesity, as well as low muscle mass and quality, were found to be associated with mortality and recurrence after resection of PDAC [11], and postoperative skeletal muscle changes were independently associated with prognostic factors [18].

BIA is widely used as it is a simple and non-invasive method that provides accurate results [19, 20]. Several reports have evaluated postoperative changes in body composition using BIA and analyzed the risk factors for postoperative complications in patients with gastric cancer [21–23]. Moreover, in patients with colorectal cancer, a preoperative low SMI based on the BIA method was considered a risk factor for postoperative ileus [24], and preoperative visceral fat area measured by BIA was an independent prognostic factor for disease-free survival [25]. Only a few studies have investigated the relationship between the prognosis after radical resection of PDAC and body composition changes assessed by BIA. Gupta et al. reported that the phase angle used as an index for evaluating cell membranes and intra- and extracellular water balance was a strong prognostic indicator in advanced PDAC, and patients with a phase angle > 5.0° had a significantly better prognosis than those with a phase angle < 5.0° (MST, 10.2 vs 6.3 months, p = 0.02) [26]. Additionally, Tozuka, et al. revealed that SMI obtained by BIA may be a predictor of treatment response and prognosis in patients with advanced PDAC who underwent gemcitabine plus nab-paclitaxel combination therapy, and the progression-free survival in the sarcopenia group was significantly lower compared with that of the non-sarcopenia group (4.4 vs 6.4 months, p = 0.03) [27]. In the current study, the SMM did not change significantly, while the BFM changed significantly from preoperatively to 12 months postoperatively; therefore, we speculated that the rate of BFM change may be a sensitive reflection of malnutrition related to prognosis. Recent reports have stated that marked loss of muscle, visceral fat, or subcutaneous fat significantly predicted shorter disease-free survival (DFS) and OS among patients with gastric cancer who underwent gastrectomy [28], and the marked loss of adipose tissue was found to be associated with a poor nutritional status. Poorer OS and DFS rates were observed in patients with marked visceral adipose tissue loss and subcutaneous adipose tissue loss during neoadjuvant treatment [29]. However, to our knowledge, no report to date has shown the relationship between postoperative BFM loss and prognosis of radical resection for PDAC. In our study, the rate of patients who underwent adjuvant chemotherapy and those who recurred, and RFS after surgery were poorer in the BLG than in the NG without a significant difference. Therefore, BFM loss in the early postoperative period may reflect poor general condition.

Among gastrointestinal cancer procedures, pancreatectomy for PDAC is a highly invasive surgery. Body composition changes result from various mechanisms, such as hyper-catabolism associated with the inflammatory reactions caused by surgical stress, reduced food intake, and a decline in activity. Furthermore, patients who underwent PDAC lose the largest percentage of BW until discharge from the department compared to those with gastric cancer and colorectal cancer [30]; however, according to another previous report considering operative methods, BW change 12 months after surgery in the PD group was significantly lower than that found in the total gastrectomy and distal gastrectomy groups [31]. There are apparent differences in the way body composition changes based on the postoperative period and operation methods. In our study, patients who underwent TP tended to lose more weight postoperatively than those who underwent PD or DP, without a significant difference, because of the small number of patients. This probably reflects the fact that most of the cases in the TP group included patients with highly malignant tumors with combined resection of the portal vein, and the surgical invasion was larger than that in corresponding patients who underwent PD or DP. There is no established method to reduce postoperative BW and BFM loss; in fact, our study showed that preoperative BFM < 12 kg and preoperative albumin < 3.5 g/dL were independently associated with BFM loss percentage at 1 month postoperatively ≧ 14%. However, no association with postoperative complications was found. This suggests the importance of preoperative factors and maintaining performance status and exercise tolerance, as reducing postoperative complications through exercise therapy and rehabilitation before and after surgery has been emphasized. In their study, Ausania et al. reported that prehabilitation that includes preoperative exercise therapy for patients with pancreatic or periampullary tumors who were candidates for pancreaticoduodenectomy was significantly associated with lower delayed gastric emptying incidence [32]. Additionally, Bundred et al. [33] indicated that prehabilitation programs may improve postoperative outcomes following pancreatic surgery. Current prehabilitaton programs for patients undergoing pancreatic resection include diverse exercise regimens, and there is no consensus regarding timing or length of prehabilitation; thus, there is a need to establish standardized prehabilitation programs in pancreatic surgery. Moreover, the importance of preoperative immunonutrition [34], pancreatic enzyme replacement therapy [35, 36], and enhanced recovery after surgery protocols [37] for patients with PDAC has been emphasized.

This study had some limitations. First, it only included patients from a single institution, and the number of patients who underwent radical resection for PDAC was small. Hence, further studies using multicenter data or a nationwide database with a larger number of patients are needed. Second, this study had a retrospective design based on data not primarily meant for research. Third, we determined cutoff values based on the ROC curves for 3-year OS after surgery; however, no specific cutoff values for the PDAC population exist and, therefore, further investigations are necessary.

BFM loss in the early postoperative period in patients having undergone radical resection for PDAC may lead to poor prognosis based on direct segmental multifrequency BIA assessment.

BFM, body fat mass; BIA, bioelectrical impedance analysis; BLG, body fat mass loss group; BMI, body mass index; BR, borderline resectable; BW, body weight; CA19-9, carbohydrate antigen 19-9; CI, confidence intervals; CT, computed tomography; DP, distal pancreatectomy; ECW/TBW, extracellular water-total body water ratio; GPS, Glasgow Prognostic Score; HR, hazard ratios; LA, locally advanced; mGPS, modified Glasgow Prognostic Score; MST, median survival time; NAC, neoadjuvant chemotherapy; NAT, neoadjuvant therapy; NG, normal group; OS, overall survival; PD, pancreatoduodenectomy; PDAC, pancreatic ductal adenocarcinoma; PNI, Prognostic Nutritional Index; RFS, relapse-free survival; ROC, receiver operating characteristic; SMI, skeletal muscle mass index; SMM, skeletal muscle mass; TP, total pancreatectomy

Ethics approval and consent to participate

This study was conducted following the principles of the Declaration of Helsinki and was approved by the Institutional Review Board of National Hospital Organization Kure Medical Center (2023-17). All patients provided written informed consent.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

None.

Authors' contributions

Study conception and design: Yoshiyuki Shibata, Takeshi Sudo

Acquisition of data: Yoshiyuki Shibata, Takeshi Sudo, Sho Tazuma, Haruki Sada, Naoki Tanimine, Norimitsu Shimada, Hirofumi Tazawa, Takahisa Suzuki, Takashi Onoe, Yosuke Shimizu,Hirotaka Tashiro,Atsushi Yamaguchi

Analysis and interpretation of data: Yoshiyuki Shibata, Takeshi Sudo

Drafting of manuscript: Yoshiyuki Shibata, Takeshi Sudo

Critical revision of manuscript: Yoshiyuki Shibata, Takeshi Sudo, Shinya Takahashi

Acknowledgements

The authors would like to thank Editage (https://www.editage.jp/) for the English language review.

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Table 1. Patients’ characteristics (n=79)

	PD (n=36)	TP (n=7)	DP (n=36)	p-value
Age, med (range), years	75 (42–84)	73 (68–79)	75 (52–89)	0.788
Sex, male, n (%)	19 (52%)	3 (43%)	19 (53%)	0.882
Neoadjuvant chemotherapy, n (%)	15 (42%)	4 (57%)	17 (47%)	0.727
Preoperative CA19-9 level, med (range), U/mL	23 (0–9784)	59 (3–727)	18 (0–1638)	0.454
Preoperative BW, med (range), kg	54 (37–85)	56 (47–73)	58 (45–70)	0.106
Preoperative BMI, med (range), kg/m²	21.2 (15.8–28.5)	21.5 (19.9–29.9)	23.1 (14.3–33.8)	0.033
Preoperative SMI, med (range), kg/m²	6.4 (4.5–8.6)	6.8 (5.6–7.1)	6.4 (5.1–9.0)	0.375
Preoperative serum albumin, med (range), g/mL	3.6 (2.2–4.3)	3.9 (2.5–4.3)	3.8 (2.5–4.8)	0.045
Preoperative PNI, med (range)	42.3 (26.1–52.0)	46.1 (29.2–54.6)	43.9 (34.7–66.3)	0.208
Preoperative GPS ≧1, n (%)	17 (47%)	2 (29%)	9 (25%)	0.131
Resectability status, n (%)
Resectable	30 (83%)	4 (57%)	28 (78%)	0.343
Borderline resectable / Unresectable	6 (17%)	3 (43%)	8 (22%)
Operating time, med (range), min	499 (350–751)	515 (345–699)	373 (205–511)	<0.001
Operative blood loss, med (range), mL	460 (50–2,000)	640 (200–3,570)	200 (30–1,200)	<0.001
Pathological tumor size, med (range), mm	27 (8–63)	40 (18–80)	26 (0–90)	0.165
Lymph node metastasis, n (%)	24 (67%)	4 (57%)	18 (50%)	0.355
Adjuvant chemotherapy, n (%)	34 (94%)	6 (87%)	29 (81%)	0.187

BMI, body mass index; BW, body weight; CA19-9, carbohydrate antigen 19-9; DP, distal pancreatectomy; GPS, Glasgow Prognostic Score; med, median; PD, pancreatoduodenectomy; PNI, Prognostic Nutritional Index; SMI, skeletal muscle mass index; TP, total pancreatectomy; U/mL, units/mL

Table 2. Univariate and multivariate overall survival analyses of poor prognostic factors (n=79)

Factors	Univariate			Multivariate
Factors	Entire (n=71)	MST (months)	p-value	HR	95% CI	p-value
Age, years
<80	59 (75%)	43.0	0.841
≥80	20 (25%)	58.2
Sex
Male	41 (52%)	43.0	0.506
Female	38 (48%)	58.2
Neoadjuvant chemotherapy
Yes	36 (46%)	64.0	0.281
No	43 (54%)	39.3
Preoperative CA19-9 level, U/mL
<100	54 (68%)	58.2	0.610
≧100	25 (32%)	39.3
Preoperative BMI, kg/m²
<18.5	7 (9%)	24.6	0.152
≧18.5	72 (91%)	58.2
Preoperative BMI, kg/m²
<25	64 (81%)	43.0	0.420
≧25	15 (19%)	58.2
Preoperative low SMI, kg/m²
Yes	34 (43%)	44.6	0.495
No	45 (57%)	58.2
Preoperative BFM, kg
<12	20 (25%)	26.7	0.092
≧12	59 (75%)	58.2
Preoperative ECW/TBW
<0.4	46 (58%)	43.0	0.871
≧0.4	33 (42%)	58.2
BFM loss percentage 1 month after surgery, %
<14	42 (53%)	64.0	0.021	1.0		0.021
≧14	37 (47%)	38.8		2.52	1.15–5.55
SMM loss percentage 1 month after surgery, %
<5	55 (70%)	44.6	0.785
≧5	24 (30%)	64.0
preoperative serum albumin, g/mL
<3.5	23 (%)	38.8	0.475
≧3.5	56 (%)	58.2
preoperative PNI
<45	44 (56%)	39.3	0.611
≧45	35 (44%)	44.6
Preoperative GPS
0	51 (65%)	58.2	0.990
≧1	28 (35%)	39.3
Resectability　status
Resectable	62 (78%)	43.0	0.985
Borderline resectable / Unresectable	17 (22%)	64.0
Surgical procedures
PD / TP	43 (54%)	44.6	0.852
DP	36 (46%)	58.2
Pathological tumor size, mm
<30	48 (61%)	58.2	0.053	1.0		0.253
≧30	31 (39%)	25.7		1.68	0.69–4.11
Lymph node metastasis
Positive	46 (58%)	39.3	0.030	3.61	1.30–10.02	0.014
Negative	33 (42%)	58.2		1.0
Surgical margin
Positive	16 (20%)	58.2	0.763
Negative	63 (80%)	44.6
Postoperative complication
Yes	6 (8%)	-	0.221
No	73 (92%)	43.0
Adjuvant chemotherapy
Yes	69 (87%)	64.0	<0.001	1.0		<0.001
No	10 (13%)	27.6		13.30	4.08–43.41

BFM, body fat mass; BMI, body mass index; CA19-9, carbohydrate antigen 19-9; CI, confidence interval; DP, distal pancreatectomy; ECW/TBW, extracellular water-total body water ratio; GPS, Glasgow Prognostic Score; HR, hazard ratio; MST, median survival time; PD, pancreatoduodenectomy; PNI, Prognostic Nutritional Index; SMI, skeletal muscle mass index; SMM, skeletal muscle mass; TP, total pancreatectomy; U/mL, units/mL

Table 3. Multivariate analyses of factors associated with BFM loss percentage at 1 month postoperatively ≧14%

Factors	Odds ratio (95% CI)	p-value
Initial CA19-9 ≧37 U/mL	0.42 (0.15–1.17)	0.098
Preoperative BFM <12 kg	4.23 (1.31–13.73)	0.016
Preoperative albumin <3.5 g/dL	3.11 (1.01–9.56)	0.047
Surgical margin positive	0.39 (0.11–1.41)	0.150
Postoperative complication	0.55 (0.08–3.66)	0.533

BFM, body fat mass; CA19-9, carbohydrate antigen 19-9; CI, confidence interval

No competing interests reported.

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published 11 Jan, 2024

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Effect of body fat mass loss on prognosis of radical resection for pancreatic ductal adenocarcinoma based on bioelectrical impedance analysis

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Neoadjuvant therapy

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