Sarcopenia and osteopenia are negative predictors for survival in patients receiving palliative chemotherapy for cholangiocellular carcinoma

Background Compared to other gastrointestinal cancers, cholangiocellular adenocarcinoma (CCA) is a rare malignancy originating from the bile ducts. Many patients already have advanced stage disease at the time of diagnosis and can therefore only receive palliative systemic therapy. Moreover, a significant part of these patients is already in a reduced general or nutritional state at the time of therapy initiation, which might negatively influence the patient´s prognosis and ability to receive therapy. Currently, however, only a few markers exist to predict the prognosis of patients. Therefore, we investigated to what extent the clinical markers sarcopenia and osteopenia affect the overall prognosis of patients suffering from CCA undergoing palliative chemotherapy.

Methods For the analysis of sarcopenia, existing CT scans in venous phase with a slice thickness of 5 mm of 29 therapy naïve CCA patients. Estimation of sarcopenia was performed by evaluating L3SMI using the 3D Slicer, a semi-automatic segmentation tool. The software calculates the L3SMI automatically by normalization to the patient´s height. Osteopenia was estimated by the trabecular bone density on CT scans at the level of lumbar vertebra 1 (L1).

Results In our retrospective cohort of patients receiving palliative chemotherapy for CCA media OS was 474 days. Both sarcopenia and osteopenia appear to be prognostic markers for OS in CCA patients. For sarcopenia, a statistically ideal cut off for L3SMI of 65 mm²/cm was used. We observed a statistically significant longer survival of patients with better muscle mass, represented by an L3SMI > 65 mm²/cm (552 days vs. 254 days; p = 0.033; HR 4.12, 95 % CI 1.13-15.11). Using 147 Hounsfield units as a statistically ideal cut off for the estimation of osteopenia, patients with higher bone density had a clear trend towards longer OS, not reaching statistical significance, yet (510 days vs. 412 days; p =  0.060; HR 2.84, CI 95 % 0.96-8.40).

Conclusion We suggest that sarcopenia and osteopenia are two potential predictive factors for overall survival in patients with CCA receiving palliative chemotherapeutic treatment. This argues for an improvement of the physical condition of the patient before starting the chemotherapeutic treatment whenever possible.

Publication History

Article published online:
07 September 2021