Sarcopenia Predicts Cancer Mortality in Male but Not in Female Patients Undergoing Surgery for Cholangiocellular Carcinoma

SIMPLE SUMMARY: Cholangiocellular adenocarcinoma is the second most common primary liver tumor. If resectable, this is the therapeutic method of choice. Unfortunately, there are insufficient prognostic markers to determine which patients benefit most from surgery and which do not. The general condition of the patient, especially their muscle mass and quality, has become more and more the focus of recent research as a possible marker for therapeutic outcome. In our study we investigated how the preoperative muscle mass of patients with cholangiocellular adenocarcinoma affects postoperative overall survival. We showed that patients with a higher preoperative muscle mass had a significantly longer survival than patients with reduced muscle mass. Furthermore, we were able to show that this is particularly relevant in men and that in women preoperative muscle mass plays a significantly less important role in postoperative survival than in men. ABSTRACT: Introduction: Surgery represents the only curative treatment option for patients with cholangiocarcinoma. However, complete tumor resection requires extensive surgery in many patients, and it is still debated which patients represent the ideal candidates for such therapy in terms of overall survival. Sarcopenia has been associated with an adverse outcome for various malignancies, but its role in the context of patients undergoing tumor resection for cholangiocellular adenocarcinoma (CCA) is only poorly understood. Here, we evaluated the role of sarcopenia in the outcome of CCA patients undergoing radical tumor resection. Methods: Pre-operative CT scans were used to assess the skeletal muscle index (L3SMI) as well as the psoas muscle index (L3PMI) in n = 76 patients receiving curative intended surgery for CCA. L3SMI and L3PMI were correlated with clinical and laboratory markers. Results: Patients with a skeletal muscle index or psoas muscle index above an established ideal cut-off (54.26 and 1.685 cm(2)/m(2)) showed a significantly better overall survival in Kaplan–Meier Curve analyses (L3SMI: 1814 days (95% CI: 520–3108) vs. 467 days (95% CI: 225–709) days; log rank X(2)(1) = 7.18, p = 0.007; L3PMI: 608 days (95% CI: 297–919) vs. 87 days (95% CI: 33–141), log rank X(2)(1) = 18.71; p < 0.001). Notably, these findings, especially for L3PMI, were confirmed in univariate (L3SMI: HR 0.962 (0.936–0.989); p = 0.006; L3PMI: HR 0.529 (0.366–0.766); p ≤ 0.001) and multivariate Cox regression analyses. Further analyses revealed that the prognostic value of both L3SMI and L3PMI was restricted to male patients, while in female patients survival was independent of the individual muscle mass. Conclusion: Measurement of muscle mass from preoperative CT scans represents an easily obtainable tool to estimate patient prognosis following curative surgery. The prognostic value was restricted to male patients, while in female patients these parameters did not reflect the patient outcome.