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Effect of Skeletal Muscle Mass Loss on Outcomes of Patients With Intraductal Papillary Mucinous Neoplasm
Soichiro Oda1, Kazumichi Kawakubo1, Ryo Takagi2
1Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.
Objective:
To investigate the association between skeletal muscle mass loss and long-term outcomes in patients with intraductal papillary mucinous neoplasm (IPMN).
Methods:
This retrospective, single-center cohort study included 700 patients diagnosed with IPMN at Hokkaido University Hospital between April 2011 and April 2023. Skeletal muscle mass was assessed using the psoas muscle index (PMI) measured on a computed tomography scan at the initial visit. The primary outcome was the incidence of pancreatic cancer, and the secondary outcome was overall mortality. Cox proportional hazard models and competing risk analyses were used to identify independent risk factors.
Results:
During a median follow-up of 71 months, 27 patients developed pancreatic cancer with an annual incidence rate of 0.63% (95% CI: 0.55%-1.86%). Patients with a low PMI had a significantly higher risk of pancreatic cancer than those with a high PMI (adjusted HR: 3.44, 95% CI: 1.62-7.32, P <0.01). Multivariate analysis identified a low PMI and a main pancreatic duct diameter ≥5 mm as independent risk factors for the development of pancreatic cancer. Among the 69 deaths, 61 were comorbidity-related and 8 were pancreatic cancer-related. Low PMI (adjusted HR: 2.57, 95% CI: 1.60-4.12, P <0.01) and a high age-adjusted Charlson comorbidity index (aCCI) (adjusted HR: 9.06, 95% CI: 4.63-17.72, P <0.01) were independently associated with all-cause mortality. Competing risk analysis revealed that skeletal muscle mass loss was significantly associated with the incidence of pancreatic cancer in patients with a low aCCI score but not in those with a high aCCI score.
Conclusions:
Skeletal muscle mass loss was an independent risk factor for all-cause mortality, and it might be associated with the risk factor for the incidence of pancreatic cancer, particularly IPMN-derived carcinoma in patients with IPMN. Patients with a low PMI and minimal comorbidities might be better to undergo long-term surveillance due to their increased risk of pancreatic cancer.
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