Sarcopenia as a prognostic factor in patients with recurrent pancreatic cancer: a retrospective study

Background: Sarcopenia is a prognostic factor in various cancers. However, the impact of sarcopenia in patients with recurrent pancreatic cancer remains unclear. This study evaluated the prognostic significance of sarcopenia in patients with recurrent pancreatic cancer. Methods Seventy-four patients who developed postoperative recurrence of pancreatic cancer after undergoing pancreatectomies were enrolled. Sarcopenia in these patients was defined according to the psoas muscle index (PMI) measured via computed tomography at the third vertebra. Results The mean PMIs at the time of recurrence were 4.47 ± 1.27 cm 2 /m 2 for men and 3.26 ± 0.70 cm 2 /m 2 for women. Of the 74 patients, 65 (87.8%) were diagnosed with sarcopenia with low PMI. The 2-year post-recurrence survival curve in the sarcopenia group was significantly worse than that in the non-sarcopenia group ( P = 0.034). Multivariate analysis revealed that sarcopenia at the time of recurrence was an independent prognostic factor ( P = 0.043) along with a high neutrophil-to-lymphocyte ratio ( P = 0.004), early recurrence ( P = 0.001) and chemotherapy after recurrence ( P = 0.005) in patients with recurrent pancreatic cancer. Furthermore, the area under the curve (AUC) of the combination of sarcopenia and time to recurrence for predicting 2-year survival was 0.763, which was much higher than that of sarcopenia alone (AUC = 0.622). Conclusions Sarcopenia is a useful prognostic factor in patients with recurrent pancreatic cancer. The combination of sarcopenia and time of recurrence may more accurately predict post-recurrence survival than can sarcopenia alone.