Impact of Preoperative Osteosarcopenia and Postoperative Administration of Pancrelipase on the Prognosis of Borderline Resectable and Unresectable Locally Advanced Pancreatic Cancer.
[BACKGROUND] This study aimed to identify postoperative recurrence and prognostic factors, including osteosarcopenia for borderline resectable (BR) and unresectable locally advanced (UR-LA) pancreatic
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APA
Matsumoto M, Uwagawa T, et al. (2025). Impact of Preoperative Osteosarcopenia and Postoperative Administration of Pancrelipase on the Prognosis of Borderline Resectable and Unresectable Locally Advanced Pancreatic Cancer.. The American surgeon, 91(1), 65-75. https://doi.org/10.1177/00031348241272420
MLA
Matsumoto M, et al.. "Impact of Preoperative Osteosarcopenia and Postoperative Administration of Pancrelipase on the Prognosis of Borderline Resectable and Unresectable Locally Advanced Pancreatic Cancer.." The American surgeon, vol. 91, no. 1, 2025, pp. 65-75.
PMID
39108198
Abstract
[BACKGROUND] This study aimed to identify postoperative recurrence and prognostic factors, including osteosarcopenia for borderline resectable (BR) and unresectable locally advanced (UR-LA) pancreatic cancer and to examine the impact of postoperative pancreatic enzyme replacement therapy (PERT).
[METHODS] We retrospectively examined 32 resected patients with BR and UR-LA pancreatic cancer. We investigated independent factors in the disease-free survival and overall survival. The relation of osteosarcopenia with the clinicopathological factors was investigated. Additionally, the association of the administration of a standard dose of pancrelipase, the amount of lipase required for patients with pancreatic exocrine insufficiency, for ≥6 months postoperatively with improvement of sarcopenia, osteopenia, and osteosarcopenia and completion rate of adjuvant chemotherapy was investigated.
[RESULTS] Multivariate analyses identified osteosarcopenia ( = 0.049) and lymph node metastasis ( = 0.01) as independent recurrence predictors, and osteosarcopenia ( = 0.002), maximum tumor diameter ≥40 mm ( = 0.006), and no adjuvant therapy ( = 0.01) as independent prognostic predictors. In the osteosarcopenia group, serum CA19-9 levels were higher ( = 0.03). The administration of a standard dose of pancrelipase for ≥6 months postoperatively was none in the osteosarcopenia group (0% vs 42.9%, = 0.01), while significantly improved postoperative sarcopenia (33% vs 0%, = 0.004), increased number of cycles of adjuvant chemotherapy (n = 6 vs n = 3, = 0.03), and the completion rate of adjuvant chemotherapy in excluding cases interrupted because of recurrence (86% vs 25%, = 0.007).
[CONCLUSIONS] Osteosarcopenia was an independent recurrent and prognostic factor in patients after pancreatectomy for locally advanced pancreatic cancer. Appropriate postoperative PERT may contribute to a better prognosis by improving sarcopenia and increasing the completion rate of adjuvant chemotherapy.
[METHODS] We retrospectively examined 32 resected patients with BR and UR-LA pancreatic cancer. We investigated independent factors in the disease-free survival and overall survival. The relation of osteosarcopenia with the clinicopathological factors was investigated. Additionally, the association of the administration of a standard dose of pancrelipase, the amount of lipase required for patients with pancreatic exocrine insufficiency, for ≥6 months postoperatively with improvement of sarcopenia, osteopenia, and osteosarcopenia and completion rate of adjuvant chemotherapy was investigated.
[RESULTS] Multivariate analyses identified osteosarcopenia ( = 0.049) and lymph node metastasis ( = 0.01) as independent recurrence predictors, and osteosarcopenia ( = 0.002), maximum tumor diameter ≥40 mm ( = 0.006), and no adjuvant therapy ( = 0.01) as independent prognostic predictors. In the osteosarcopenia group, serum CA19-9 levels were higher ( = 0.03). The administration of a standard dose of pancrelipase for ≥6 months postoperatively was none in the osteosarcopenia group (0% vs 42.9%, = 0.01), while significantly improved postoperative sarcopenia (33% vs 0%, = 0.004), increased number of cycles of adjuvant chemotherapy (n = 6 vs n = 3, = 0.03), and the completion rate of adjuvant chemotherapy in excluding cases interrupted because of recurrence (86% vs 25%, = 0.007).
[CONCLUSIONS] Osteosarcopenia was an independent recurrent and prognostic factor in patients after pancreatectomy for locally advanced pancreatic cancer. Appropriate postoperative PERT may contribute to a better prognosis by improving sarcopenia and increasing the completion rate of adjuvant chemotherapy.
MeSH Terms
Humans; Pancreatic Neoplasms; Male; Female; Retrospective Studies; Sarcopenia; Aged; Middle Aged; Prognosis; Lipase; Neoplasm Recurrence, Local; Chemotherapy, Adjuvant; Pancreatectomy; Postoperative Care; Aged, 80 and over; Disease-Free Survival
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