Prognostic Role of CT-Derived Muscle and Adipose Tissue Parameters After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: An Exploratory Analysis
Istanbul Medical Journal, cilt.27, sa.3, ss.259-267, 2026 (ESCI, Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 27 Sayı: 3
- Basım Tarihi: 2026
- Doi Numarası: 10.4274/imj.galenos.2026.24886
- Dergi Adı: Istanbul Medical Journal
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.259-267
- Anahtar Kelimeler: Pancreatic ductal adenocarcinoma, pancreaticoduodenectomy, body composition, sarcopenia, myosteatosis, computed tomography, psoas muscle attenuation, visceral adipose tissue, survival analysis, prognostic biomarkers
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Introduction: Body composition abnormalities, including sarcopenia and adipose tissue alterations, have emerged as potential prognostic biomarkers in pancreatic ductal adenocarcinoma (PDAC). The present study investigated the relationship between preoperative computed tomography (CT)-derived adipose and muscle parameters and survival outcomes in patients undergoing pancreaticoduodenectomy for PDAC. Methods: This retrospective analysis enrolled 69 patients with histologically confirmed PDAC who underwent pancreaticoduodenectomy between 2018 and 2024. Preoperative contrast-enhanced CT images acquired within 30 days before surgery were assessed at the level of the third lumbar vertebra (L3). Measurements included the area and attenuation of visceral and subcutaneous adipose tissue, as well as the area and attenuation of the psoas muscle. Overall survival (OS) and disease-free survival (DFS) were evaluated using Kaplan-Meier survival curves and Cox proportional hazards models. Results: Median OS and DFS were 10.0 and 7.0 months, respectively. Kaplan-Meier analyses showed no statistically significant differences in survival across body composition parameters (all p>0.05), although several parameters exhibited consistent numerical trends in survival. In multivariable analysis, higher T stage was independently associated with worse OS [hazard ratio (HR): 1.83, 95% confidence interval (CI): 1.12-3.00, p=0.015], whereas adjuvant chemotherapy remained independently associated with improved OS (HR: 0.16, 95% CI: 0.07-0.34, p<0.001). Because of the limited number of DFS events, multivariable analysis was not performed. Conclusion: CT-derived body composition analysis may provide complementary prognostic information in patients undergoing pancreaticoduodenectomy for PDAC. Although independent associations were not consistently demonstrated, the observed survival patterns support further investigation of CT-derived muscle and adipose tissue parameters as potential imaging biomarkers. Larger prospective multicenter studies are warranted to clarify their prognostic value.