Sarkopenie als unabhängiger Prognosefaktor bei Pankreaskarzinom

Zusammenfassung

Einleitung Die Diagnose Pankreaskarzinom zählt trotz modernster Diagnose- und Therapieoptionen zu den häufigsten krebsbedingten globalen Todesursachen. Häufig liegt bei diesen Patienten eine Kachexie und Sarkopenie vor.

Methode In einer retrospektiven Analyse wurde die jeweilige Querschnittsfläche der Skelettmuskulatur auf Höhe des Lendenwirbelkörpers L 3 im axialen CT-Schnittbild von 121 Patienten bestimmt, um so den Skelettmuskelindex (SMI [cm²/m²]) zu erhalten. Es erfolgte außerdem eine Erfassung weiterer Parameter zur zusätzlichen Evaluation deren Assoziation mit der Überlebenswahrscheinlichkeit.

Ergebnisse Die durchschnittliche Überlebenszeit der Gruppe der sarkopenen Patienten war mit 14,4 Monaten im Vergleich zu 17,7 Monaten mittlerer Überlebenszeit bei Patienten ohne Sarkopenie signifikant vermindert (p=0,046). Zusätzlich konnten das Alter (p = 0,006), eine nicht erfolgte Resektion des Tumors (p=0,004), Metastasen bei Erstdiagnose (p=0,002) sowie ein erhöhtes CA 19–9 (p=0,002) als statistisch signifikante negative Prognosefaktoren identifiziert werden.

Schlussfolgerung Sarkopenie ist ein unabhängiger prognostischer Faktor in Bezug auf die Überlebenszeit bei Pankreaskarzinompatienten. Dies legt die standardmäßige Integration des SMI als Prognoseparameter in den klinischen Alltag nahe, um durch entsprechende präventive und therapeutische ernährungs- und bewegungsmedizinische Maßnahmen möglicherweise die Lebensdauer sowie die Lebensqualität von Pankreaskarzinompatienten merklich verbessern zu können.

Abstract

Background Pancreatic cancer is despite modern diagnostic tools and treatment regimen associated with poor outcome. Many patients show cachexia and sarcopenia.

Methods In a retrospective analysis the SMI (cm²/m²) was measured by determining the skelettal muscle area in a computed tomography image at lumbar vertebrae 3. Further clinical parameters were measured to determine the outcome.

Results The mean survival after diagnosis in the population with sarcopenia was significantly lower (14,4 vs 17,7 months, p=0,046). Significantly shorter survival was also seen for higher age (p=0,006), no tumor resection (p=0,004), metastases (p=0,002) and high CA19–9 level (p=0,002)

Conclusion Sarcopenia is an indipendant prognostic factor in patients with pancreatic cancer. SMI should be measured clinical practice and further studies are necessary to asses a potential therapeutic strategy.

Schlüsselwörter

Sarkopenie - Pankreaskarzinom - Kachexie

Keywords

sarcopenia - pancreatic cancer - cancer cachexia

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