Clinical impact of body composition on postoperative outcomes during neoadjuvant chemoradiation therapy for distal bile duct cancer

Fujii,Wataru; Wada,Hiroshi; Hasegawa,Shinichiro; Mukai,Yosuke; Asukai,Kei; Akita,Hirofumi; Sugase,Takahito; Yamamoto,Masaaki; Takeoka,Tomohira; Shinno,Naoki; Hara,Hisashi; Kanemura,Takeshi; Haraguchi,Naotsugu; Nishimura,Junichi; Yasui,Masayoshi; Matsuda,Chu; Omori,Takeshi; Miyata,Hiroshi; Ohue,Masayuki; Sakon,Masato; Takahashi,Hidenori

doi:10.3892/mco.2022.2542

Clinical impact of body composition on postoperative outcomes during neoadjuvant chemoradiation therapy for distal bile duct cancer

Authors:
- Wataru Fujii
- Hiroshi Wada
- Shinichiro Hasegawa
- Yosuke Mukai
- Kei Asukai
- Hirofumi Akita
- Takahito Sugase
- Masaaki Yamamoto
- Tomohira Takeoka
- Naoki Shinno
- Hisashi Hara
- Takeshi Kanemura
- Naotsugu Haraguchi
- Junichi Nishimura
- Masayoshi Yasui
- Chu Matsuda
- Takeshi Omori
- Hiroshi Miyata
- Masayuki Ohue
- Masato Sakon
- Hidenori Takahashi
View Affiliations

Affiliations: Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541‑8567, Japan
Published online on: May 11, 2022 https://doi.org/10.3892/mco.2022.2542
Article Number: 109

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Body composition changes during neoadjuvant therapy and their clinical significance have not been clarified. The present study aimed to investigate body composition changes during neoadjuvant chemoradiation therapy (NACRT) in patients with distal bile duct cancer and the clinical impact on postoperative complications and the prognosis. A total of 16 patients with distal bile duct cancer who underwent curative resection after NACRT were retrospectively evaluated. The area of skeletal muscle, visceral fat and subcutaneous fat on computed tomography and immunological and nutritional indices were assessed before and after NACRT. All 16 patients completed NACRT followed by pancreaticoduodenectomy without mortality. There was no significant change in the skeletal muscle mass index (SMI) during NACRT. Of the 16 patients, nine (56%) were defined as sarcopenic before NACRT, and eight (50%) met the criteria for sarcopenic after NACRT. The SMI and total fat area were significantly associated with postoperative pancreatic fistula (POPF) (P=0.019 and P=0.007, respectively). The patients with sarcopenia had a shorter disease‑free survival time and overall survival time in comparison to patients without sarcopenia (P=0.025 and P=0.115, respectively). In conclusion, NACRT for distal bile duct cancer did not significantly affect the body composition, or the immunological or nutritional indices. Sarcopenia after NACRT was significantly associated with early recurrence in patients with distal bile duct cancer who received NACRT.

View Figures

View References

1	Miyakawa S, Ishihara S, Horiguchi A, Takada T, Miyazaki M and Nagakawa T: Biliary tract cancer treatment: 5,584 Results from the biliary tract cancer statistics registry from 1998 to 2004 in Japan. J Hepatobiliary Pancreat Surg. 16:1–7. 2009.PubMed/NCBI View Article : Google Scholar
2	Kobayashi S, Gotoh K, Takahashi H, Akita H, Marubashi S, Yamada T, Teshima T, Nishiyama K, Yano M, Ohigashi H, et al: Clinicopathological features of surgically-resected biliary tract cancer following chemo-radiation therapy. Anticancer Res. 36:335–342. 2016.PubMed/NCBI
3	Ohigashi H, Ishikawa O, Eguchi H, Takahashi H, Gotoh K, Yamada T, Yano M, Nakaizumi A, Uehara H, Tomita Y and Nishiyama K: Feasibility and efficacy of combination therapy with preoperative full-dose gemcitabine, concurrent three-dimensional conformal radiation, surgery, and postoperative liver perfusion chemotherapy for T3-pancreatic cancer. Ann Surg. 250:88–95. 2009.PubMed/NCBI View Article : Google Scholar
4	Dindo D, Demartines N and Clavien PA: Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 240:205–213. 2004.PubMed/NCBI View Article : Google Scholar
5	Nishikawa H, Shiraki M, Hiramatsu A, Moriya K, Hino K and Nishiguchi S: Japan society of hepatology guidelines for sarcopenia in liver disease (1st edition): Recommendation from the working group for creation of sarcopenia assessment criteria. Hepatol Res. 46:951–963. 2016.PubMed/NCBI View Article : Google Scholar
6	Yip C, Goh V, Davies A, Gossage J, Mitchell-Hay R, Hynes O, Maisey N, Ross P, Gaya A, Landau DB, et al: Assessment of sarcopenia and changes in body composition after neoadjuvant chemotherapy and associations with clinical outcomes in oesophageal cancer. Eur Radiol. 24:998–1005. 2014.PubMed/NCBI View Article : Google Scholar
7	Awad S, Tan BH, Cui H, Bhalla A, Fearon KC, Parsons SL, Catton JA and Lobo DN: Marked changes in body composition following neoadjuvant chemotherapy for oesophagogastric cancer. Clin Nutr. 31:74–77. 2012.PubMed/NCBI View Article : Google Scholar
8	Reisinger KW, Bosmans JW, Uittenbogaart M, Alsoumali A, Poeze M, Sosef MN and Derikx JP: Loss of skeletal muscle mass during neoadjuvant chemoradiotherapy predicts postoperative mortality in esophageal cancer surgery. Ann Surg Oncol. 22:4445–4452. 2015.PubMed/NCBI View Article : Google Scholar
9	Mirkin KA, Luke FE, Gangi A, Pimiento JM, Jeong D, Hollenbeak CS and Wong J: Sarcopenia related to neoadjuvant chemotherapy and perioperative outcomes in resected gastric cancer: A multi-institutional analysis. J Gastrointest Oncol. 8:589–595. 2017.PubMed/NCBI View Article : Google Scholar
10	Levolger S, Van Vledder MG, Alberda WJ, Verhoef C, De Bruin RWF, Ijzermans JNM and Burger JW: Muscle wasting and survival following pre-operative chemoradiotherapy for locally advanced rectal carcinoma. Clin Nutr. 37:1728–1735. 2018.PubMed/NCBI View Article : Google Scholar
11	Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, Madhusudan S, Iveson T, Hughes S, Pereira SP, et al: Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 362:1273–1281. 2010.PubMed/NCBI View Article : Google Scholar
12	Okusaka T, Ishii H, Funakoshi A, Yamao K, Ohkawa S, Saito S, Saito H and Tsuyuguchi T: Phase II study of single-agent gemcitabine in patients with advanced biliary tract cancer. Cancer Chemother Pharmacol. 57:647–653. 2006.PubMed/NCBI View Article : Google Scholar
13	Otsuji H, Yokoyama Y, Ebata T, Igami T, Sugawara G, Mizuno T and Nagino M: Preoperative sarcopenia negatively impacts postoperative outcomes following major hepatectomy with extrahepatic bile duct resection. World J Surg. 39:1494–1500. 2015.PubMed/NCBI View Article : Google Scholar
14	Pamoukdjian F, Bouillet T, Levy V, Soussan M, Zelek L and Paillaud E: Prevalence and predictive value of pre-therapeutic sarcopenia in cancer patients: A systematic review. Clin Nutr. 37:1101–1113. 2018.PubMed/NCBI View Article : Google Scholar
15	Mathur A, Pitt HA, Marine M, Saxena R, Schmidt CM, Howard TJ, Nakeeb A, Zyromski NJ and Lillemoe KD: Fatty pancreas: A factor in postoperative pancreatic fistula. Ann Surg. 246:1058–1064. 2007.PubMed/NCBI View Article : Google Scholar
16	Sandini M, Bernasconi DP, Ippolito D, Nespoli L, Baini M, Barbaro S, Fior D and Gianotti L: Preoperative computed tomography to predict and stratify the risk of severe pancreatic fistula after pancreatoduodenectomy. Medicine (Baltimore). 94(e1152)2015.PubMed/NCBI View Article : Google Scholar
17	Chakedis J, Spolverato G, Beal EW, Woelfel I, Bagante F, Merath K, Sun SH, Chafitz A, Galo J, Dillhoff M, et al: Pre-operative sarcopenia identifies patients at risk for poor survival after resection of biliary tract cancers. J Gastrointest Surg. 22:1697–1708. 2018.PubMed/NCBI View Article : Google Scholar
18	Cooper AB, Slack R, Fogelman D, Holmes HM, Petzel M, Parker N, Balachandran A, Garg N, Ngo-Huang A, Varadhachary G, et al: Characterization of anthropometric changes that occur during neoadjuvant therapy for potentially resectable pancreatic cancer. Ann Surg Oncol. 22:2416–2423. 2015.PubMed/NCBI View Article : Google Scholar
19	Shachar SS, Williams GR, Muss HB and Nishijima TF: Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review. Eur J Cancer. 57:58–67. 2016.PubMed/NCBI View Article : Google Scholar
20	Okumura S, Kaido T, Hamaguchi Y, Fujimoto Y, Kobayashi A, Iida T, Yagi S, Taura K, Hatano E and Uemoto S: Impact of the preoperative quantity and quality of skeletal muscle on outcomes after resection of extrahepatic biliary malignancies. Surgery. 159:821–833. 2016.PubMed/NCBI View Article : Google Scholar
21	Eriksson S, Nilsson JH, Strandberg Holka P, Eberhard J, Keussen I and Sturesson C: The impact of neoadjuvant chemotherapy on skeletal muscle depletion and preoperative sarcopenia in patients with resectable colorectal liver metastases. HPB (Oxford). 19:331–337. 2017.PubMed/NCBI View Article : Google Scholar
22	Pratesi A, Tarantini F and Di Bari M: Skeletal muscle: An endocrine organ. Clin Cases Miner Bone Metab. 10:11–14. 2013.PubMed/NCBI View Article : Google Scholar