Prognostic significance of sarcopenia in advanced biliary tract cancer patients

Abstract

Purpose: Sarcopenia and systemic inflammation is getting its attention in patients with malignancy as systemic inflammation and low muscularity have great impact on the survival of cancer patients. There are few studies regarding how the sarcopenia and systemic inflammation affect the prognosis in biliary tract cancer with distant metastasis have been studied. Based on this background, we aimed to investigate the association between the sarcopenia with systemic inflammation and prognosis between the patients with metastatic biliary tract cancer. Materials and Methods: A total 353 patients with metastatic biliary tract cancer patients from 2007 to 2016 were analyzed. To evaluate the skeletal muscle mass, the computed tomography image at upper level of 3rd lumbar vertebra (L3) was used. We defined the sarcopenia as follows using Japan Society of Hepatology guideline; L3 muscle index < 42 cm2/m2 for male and < 38cm2/m2 for female patients. The systemic inflammation status was evaluated using the neutrophil lymphocyte ratio (NLR). Patients with NLR>3 was categorized into patients with inflammatory status. The overall survival (OS) and progression free survival (PFS) were analyzed. The subgroup analysis was performed those who received gemcitabine/cisplatin (GP) chemotherapy. The OS and PFS of patients who received GP chemotherapy were analyzed depending on sarcopenia and inflammatory status. Results: Patients with sarcopenia showed inferior 1-year OS compared to patients without sarcopenia (25.5% vs 38.2%, p=0.019). Concordant to other studies, the patients with high NLR (NLR>3) were associated with inferior OS than low NLR (NLR≤3) (21.0% vs 52.8%, p<0.001). Based on this results, we categorized the patients into 3 groups; patients with sarcopenia accompanied high NLR, patients without sarcopenia and low NLR, and either sarcopenia or high NLR. The OS of patients was well stratified according to this grouping (1-year OS; 18.3% vs 30.3% vs 55.8%, p<0.001). Concordant with OS results, the PFS was well stratified based on either sarcopenia or NLR (Sarcopenia; 9.5% vs 19.4%, p<0.001, NLR; 10.0% vs 23.4%, p<0.001). The PFS was significantly associated with group depending on NLR and sarcopenia (1-year PFS; 7.8% vs 13.0% vs 27.9%, p<0.001). Conclusion: We find out that the sarcopenia coexist with inflammatory status is notably associated with inferior OS and also PFS. Based on results that sarcopenia accompanied with inflammatory status has been associated with poor prognosis, the conservative treatment such as nutritional support, exercise and pharmacologic intervention would be helpful to these patients in metastatic biliary tract cancer to overcome the sarcopenia and inflammatory status.