Integrating Body Composition and Nutritional Indices: A Novel Prognostic Tool for Survival in Pancreatic Cancer

IF 9.1 1区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of Cachexia Sarcopenia and Muscle Pub Date : 2025-07-09 DOI:10.1002/jcsm.70006

Yiting Xu, Yang Chen, Gaowei Jin, Chenrui Yao, Yangyang Wang, Ziyang Wei, Zhihang Cai, Xuanhao Gu, Binbin Deng, Peilu Wang, Yuxiong Feng, Qi Zhang, Tingbo Liang

{"title":"Integrating Body Composition and Nutritional Indices: A Novel Prognostic Tool for Survival in Pancreatic Cancer","authors":"Yiting Xu, Yang Chen, Gaowei Jin, Chenrui Yao, Yangyang Wang, Ziyang Wei, Zhihang Cai, Xuanhao Gu, Binbin Deng, Peilu Wang, Yuxiong Feng, Qi Zhang, Tingbo Liang","doi":"10.1002/jcsm.70006","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Sarcopenia and malnutrition have been independently associated with a poorer prognosis in pancreatic ductal adenocarcinoma (PDAC), but their combined association with patient outcomes is not fully understood. This study aimed to systematically evaluate the synergistic effects of body composition parameters and nutritional index as prognostic indicators in patients with PDAC.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A total of 596 patients with PDAC who underwent surgical resection from two centres were initially enrolled in this retrospective study. Body composition parameters, including the skeletal muscle index (SMI), subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI) and skeletal muscle density (SMD), were assessed using a single cross-sectional image at the L3 level from preoperative computed tomography scans. The prognostic nutritional index (PNI) was used to assess nutritional status. The combined indices were defined as body composition parameters multiplied by PNI.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 463 patients were finally included in the analysis, with 339 in the training cohort and 124 in the validation cohort. The median (interquartile) age was 66 (60–72) years, and 274 (59.2%) were male. The median values of SMI, SATI, VATI, SMD, as well as the combined indices of these parameters with PNI, varied significantly by sex in the training cohort. Patients were categorized into sex-specific quartiles (Q1 to Q4) based on SMI × PNI levels. Both overall survival (OS) and disease-free survival (DFS) exhibited significant differences across these quartiles (<i>p</i> < 0.001). Though all body composition parameters and their combinations with PNI were independent predictors of OS in multivariate analysis, the combination of SMI × PNI demonstrated superior prognostic performance compared to other indices (c-statistics: 0.767, AICc: 1648.8). These results remained consistent across stratified analysis. The external validation cohort confirmed that SMI × PNI exhibited enhanced predictive and discriminative power compared with other indices.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>SMI × PNI represents a robust and accessible prognostic tool for assessing survival in patients with PDAC. Further prospective studies are needed to validate its effectiveness across diverse populations and clinical settings.</p>\n </section>\n </div>","PeriodicalId":48911,"journal":{"name":"Journal of Cachexia Sarcopenia and Muscle","volume":"16 4","pages":""},"PeriodicalIF":9.1000,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcsm.70006","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cachexia Sarcopenia and Muscle","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jcsm.70006","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Sarcopenia and malnutrition have been independently associated with a poorer prognosis in pancreatic ductal adenocarcinoma (PDAC), but their combined association with patient outcomes is not fully understood. This study aimed to systematically evaluate the synergistic effects of body composition parameters and nutritional index as prognostic indicators in patients with PDAC.

Methods

A total of 596 patients with PDAC who underwent surgical resection from two centres were initially enrolled in this retrospective study. Body composition parameters, including the skeletal muscle index (SMI), subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI) and skeletal muscle density (SMD), were assessed using a single cross-sectional image at the L3 level from preoperative computed tomography scans. The prognostic nutritional index (PNI) was used to assess nutritional status. The combined indices were defined as body composition parameters multiplied by PNI.

Results

A total of 463 patients were finally included in the analysis, with 339 in the training cohort and 124 in the validation cohort. The median (interquartile) age was 66 (60–72) years, and 274 (59.2%) were male. The median values of SMI, SATI, VATI, SMD, as well as the combined indices of these parameters with PNI, varied significantly by sex in the training cohort. Patients were categorized into sex-specific quartiles (Q1 to Q4) based on SMI × PNI levels. Both overall survival (OS) and disease-free survival (DFS) exhibited significant differences across these quartiles (p < 0.001). Though all body composition parameters and their combinations with PNI were independent predictors of OS in multivariate analysis, the combination of SMI × PNI demonstrated superior prognostic performance compared to other indices (c-statistics: 0.767, AICc: 1648.8). These results remained consistent across stratified analysis. The external validation cohort confirmed that SMI × PNI exhibited enhanced predictive and discriminative power compared with other indices.

Conclusions

SMI × PNI represents a robust and accessible prognostic tool for assessing survival in patients with PDAC. Further prospective studies are needed to validate its effectiveness across diverse populations and clinical settings.

Abstract Image

查看原文本刊更多论文

综合身体成分和营养指标：胰腺癌生存的新预后工具

研究背景：肌少症和营养不良与胰腺导管腺癌（PDAC）患者预后较差独立相关，但它们与患者预后的综合关系尚不完全清楚。本研究旨在系统评价体成分参数和营养指数作为PDAC患者预后指标的协同作用。方法回顾性研究了来自两个中心的596例接受手术切除的PDAC患者。身体组成参数，包括骨骼肌指数（SMI）、皮下脂肪组织指数（SATI）、内脏脂肪组织指数（VATI）和骨骼肌密度（SMD），使用术前计算机断层扫描的L3层单横截面图像进行评估。预后营养指数（PNI）用于评估营养状况。综合指标定义为体成分参数乘以PNI。结果最终纳入463例患者，其中训练组339例，验证组124例。年龄中位数（四分位数间）为66岁（60-72岁），男性274例（59.2%）。在培训队列中，SMI、SATI、VATI、SMD的中位数以及这些参数与PNI的联合指数在性别上存在显著差异。根据SMI × PNI水平将患者分为性别特异性四分位数（Q1至Q4）。总生存期（OS）和无病生存期（DFS）在这些四分位数中均表现出显著差异（p < 0.001）。虽然在多变量分析中，所有身体成分参数及其与PNI的联合是OS的独立预测因素，但SMI × PNI联合治疗比其他指标具有更好的预后效果（c-statistics: 0.767, AICc: 1648.8）。这些结果在分层分析中保持一致。外部验证队列证实，与其他指标相比，SMI × PNI具有更强的预测和判别能力。结论SMI × PNI是评估PDAC患者生存的一种可靠且可获得的预后工具。需要进一步的前瞻性研究来验证其在不同人群和临床环境中的有效性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Cachexia Sarcopenia and Muscle MEDICINE, GENERAL & INTERNAL-

CiteScore

13.30

自引率

12.40%

发文量

234

审稿时长

16 weeks

期刊介绍： The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.