Association Between Computed Tomography–Based AI-Derived Body Composition and Survival in Patients With Pancreatic Ductal Adenocarcinoma

The American Journal of Gastroenterology, vol. 121, pp. 982–992

Abstract

INTRODUCTION: A deeper understanding of the factors influencing survival in patients with pancreatic ductal adenocarcinoma (PDAC) is essential for optimizing treatment strategies. This study investigates the independent association of body composition parameters with overall survival in patients with PDAC. METHODS: This retrospective multisite cohort study included patients diagnosed with PDAC. Diagnostic computed tomography scans were retrieved, and body composition was evaluated using a validated deep learning-based segmentation algorithm that measured tissue volume and density in a 20 cm vertical abdominal section. RESULTS: A total of 1,666 patients with PDAC were included, 938 male (56.3%) and median age 69 years (interquartile range 61-76). In the subgroup of patients who underwent surgical resection (n = 509), myosteatosis (intramuscular infiltration of adipose tissue; hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.16-2.11, P = 0.004), sarcopenic obesity (HR 1.75, 95% CI 1.06-2.91, P = 0.03), and less subcutaneous adipose tissue (HR 1.09, 95% CI 1.03-1.16, P = 0.002) were associated with higher mortality. In patients receiving palliative systemic therapy (n = 439), lower skeletal muscle density (HR 1.43, 95% CI 1.03-1.99, P = 0.03) was associated with higher mortality. In patients who did not undergo tumor-targeted treatment (n = 718), less visceral adipose tissue (HR 1.04, 95% CI 1.01-1.08, P = 0.02) was associated with higher mortality. DISCUSSION: Body composition parameters, derived from computed tomography scans at the time of PDAC diagnosis, particularly low skeletal muscle density, sarcopenic obesity, and low adipose tissue, are independently associated with overall survival in patients with PDAC. Evaluating body composition at diagnosis could enhance clinical decision-making and enable more personalized treatment strategies.

Authors 11

1. Koen Wijsman Aachen Department of Gastroenterology and Hepatology

   Leiden University Medical Center · Mayo Clinic in Florida

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands;

   Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA;

2. Derk C.F. Klatte Aachen Department of Gastroenterology and Hepatology

   Leiden University Medical Center · Mayo Clinic in Florida

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands;

   Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA;

3. Hani M. Babiker

   Mayo Clinic in Florida · Mayo Clinic Comprehensive Cancer Center (Florida)

   Affiliation as printed

   Division of Hematology and Oncology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA;

4. Aleksander M. Bogdanski Aachen Department of Gastroenterology and Hepatology

   Leiden University Medical Center · Mayo Clinic in Florida

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands;

   Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA;

5. Brandon R. Grossardt

   Mayo Clinic

   Affiliation as printed

   Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA;

6. Jeanin Elise van Hooft Aachen Department of Gastroenterology and Hepatology

   Leiden University Medical Center

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands;

7. Monique Esther van Leerdam Aachen Department of Gastroenterology and Hepatology

   Leiden University Medical Center · The Netherlands Cancer Institute

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands;

   Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands;

8. J. Sven D. Mieog Aachen Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands;

9. Alexander D. Weston

   Mayo Clinic · Mayo Clinic in Florida

   Affiliation as printed

   Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA

10. Michael B. Wallace

    Mayo Clinic in Florida

    Affiliation as printed

    Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA;

11. Yan Bi

    Mayo Clinic in Florida

    Affiliation as printed

    Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA;