A low skeletal muscle index in the early period following surgery is associated with shorter overall survival and recurrence-free survival in patients with perihilar cholangiocarcinoma (pCCA) who underwent major hepatectomy with extrahepatic bile duct resection and reconstruction, a study found.

This is according to a new study published in the journal BMC Cancer. Low skeletal muscle index could therefore be used as a predictor for recurrence and poor survival.

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Preoperative sarcopenia can predict poor survival in many types of cancer. To assess whether changes in skeletal muscle mass after surgery could be associated with survival in patients with pCCA, a team of researchers from Japan studied 56 patients with the disease who underwent surgery.

All patients had major hepatectomy with extrahepatic bile duct resection and almost half (46%) had sarcopenia before the operation. In the early period following surgery, 52% of patients had decreased skeletal muscle index. 

At follow-up, which ranged from 4 to 7 years, the disease recurred in the majority of patients (63%) and half of the patients died. 

The researchers reported an independent association between decreased skeletal muscle index and overall, and recurrence-free survival. There was no such association between high levels of carbohydrate antigen (CA) 19–9 and survival.

The researchers concluded that skeletal muscle index is a better predictor for recurrence and poor survival in pCCA in the early postoperative period compared to serum levels of CA 19–9 and that evaluating skeletal muscle index on serial computed tomography is “considered to be useful for monitoring patients after surgery.”

pCCA is a subtype of extrahepatic cholangiocarcinoma localized in the biliary tree, proximal to the origin of the cyst duct. Treatment for all types of CCA typically consists of surgical intervention and adjuvant therapies like targeted radiotherapy. 

Reference

Yasuta S, Sugimoto M, Kudo M, et al. Early postoperative decrease of skeletal muscle mass predicts recurrence and poor survival after surgical resection for perihilar cholangiocarcinoma. BMC Cancer. Published online December 28, 2022. doi:10.1186/s12885-022-10453-2