Sarcopenia and osteopenia are negative predictors of postoperative survival in cholangiocellular carcinoma

Background Cholangiocellular adenocarcinoma (CCA) is a malignant tumor originating from the bile duct epithelium. The incidence in Europe is about 2-3/100,000 people. Therapeutically, surgical resection of the tumor is the best treatment option, as this is the only way to cure the disease. Many patients are in a reduced general or nutritional condition at the time of diagnosis. Currently, it is unclear to what extent this affects the overall prognosis of the patients. Therefore, in this retrospective analysis, we aim to investigate the impact of preoperative sarcopenia and osteopenia as markers of patients´ general condition on overall survival (OS) after resection of CCA.

Methods For the analysis of sarcopenia, existing CT scans in venous phase with a slice thickness of 5 mm of 36 preoperative CCA patients were used. Sarcopenia is evaluated using the skeletal muscle index (L3SMI) by using the open-source, semi-automatic segmentation tool 3D Slicer. The software automatically calculates the mean skeletal muscle attenuation (MMA) as an absolute value and the skeletal muscle index (L3SMI) is calculated by normalization to the patient´s height. For the analysis of osteopenia, the trabecular bone density is determined on CT scans at the level of the first lumbar vertebra (L1).

Results The median overall survival of our retrospective cohort of 36 patients operated on CCA was 608 days. We could identify a significant impact for both sarcopenia and osteopenia on overall survival following CCA resection. Using a statistically ideal cut off for L3SMI of 78 mm²/cm as a marker for sarcopenia, we demonstrated a significant difference in median overall survival between the two groups (290 days vs. 841 days; p = 0.02; HR 2.66; 95 % CI 1.17 - 6.08). Similar to this finding, we were able to demonstrate for osteopenia an even more pronounced difference in median OS of the patients using a cut off of 140 Hounsfield units (403 days vs. 1435 days; p = 0.0018; HR 4.29; 95 % CI 1.72 - 10.71).

Conclusion Our retrospective study suggests that sarcopenia and osteopenia are two relevant predictive factors for overall survival in resectable CCA. Our results suggest that improving the physical condition of the patient before tumor resection may improve the OS.

Publication History

Article published online:
07 September 2021