Preoperative myosteatosis and prognostic nutritional index predict overall survival in older patients (aged ≥ 80 years) with resected biliary tract cancer: a retrospective cohort study

Background: Several studies have demonstrated the prognostic value of sarcopenia and the systemic inflammatory response in patients with cancer. The aim of this study was to evaluate the prognostic significance of sarcopenia (myopenia and myosteatosis) and systemic inflammatory markers in older patients (aged ≥ 80 years) with resected biliary tract cancer. Methods: : Patients who underwent resection for biliary tract cancer between July 2010 and January 2023 were retrospectively reviewed. Myopenia and myosteatosis, as indicated by the psoas muscle index and intramuscular adipose tissue content/modified intramuscular adipose tissue content, were measured on preoperative computed tomography. Associations between clinicopathological characteristics, inflammation-based prognostic scores, and overall survival were analyzed using Cox proportional hazards models. P < 0.05 was considered statistically significant. Results: : Univariate analysis showed that a low C-reactive protein-to-albuminratio (< 0.125), a low prognostic nutritional index (< 42), a low modified intramuscular adipose tissue content, a high T-stage (T3–4), lymph node metastasis, and postoperative complications were associated with worse overall survival in older patients (aged ≥ 80 years) with resected biliary tract cancer ( n = 48). A low prognostic nutritional index (< 42) ( P = 0.007), a low modified intramuscular adipose tissue content ( P = 0.015), a high T-stage (T3–4)( P < 0.001), lymph node metastasis ( P = 0.001), and postoperative complications ( P = 0.017) were independent predictors of overall survival in multivariate analysis. Conclusions: : Preoperative myosteatosis and low prognostic nutritional index are independentprognostic factors for overall survival in older patients (aged ≥ 80 years) with resected biliary tract cancer. Preoperative myosteatosis and prognostic nutritional index may be useful for risk stratification and clinical decision-making. Early interventions, such as nutritional support and physical exercise, may improve outcomes after resection of biliary tract cancer. Trial registration: Not applicable.