Prognostic value of body composition on early recurrence and long-term survival of resectable pancreatic ductal adenocarcinoma

OBJECTIVE: To explore the associations of CT-evaluated body composition with early recurrence (ER) and overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC) after resection. MATERIALS AND METHODS: A retrospective analysis was performed on consecutively enrolled patients who underwent surgical resection for PDAC between 2014 and 2023. Patients were divided into a training set (n = 412) and a validation set (n = 120). Sex-specific cutoff values were determined for body composition indices, including visceral-to-subcutaneous fat ratio (VSR), skeletal muscle density (SMD), subcutaneous fat area (SFA), and other metrics. Logistic regression and Cox proportional hazards models were used to analyze the associations of body composition with ER and OS. Subgroup analyses were conducted based on clinicopathological characteristics to explore the prognostic value of body composition. RESULTS: High VSR was an independent predictor for ER (OR: 2.304, p = 0.001) and worse OS (HR: 1.462, p = 0.007), whereas high SMD (HR: 0.609, p = 0.005) and high SFA (HR: 0.649, p = 0.002) were independent predictors for better OS. Subgroup analyses revealed variations in the prognostic effect of VSR according to diabetes status and tumor size. A model combining body composition metrics and clinicopathological indicators (carbohydrate antigen 19-9, carbohydrate antigen 12-5, tumor-node-metastasis stage, lymphovascular invasion, and adjuvant therapy) demonstrated good predictive ability for ER, with AUCs of 0.80 in the training set and 0.82 in the validation set. CONCLUSION: High VSR was an independent predictor for ER and worse OS in PDAC. Moreover, combining body composition metrics and clinicopathological indicators can improve the prognosis prediction of patients with PDAC after surgery. KEY POINTS: Question What are the associations of CT-evaluated body composition with early recurrence and overall survival in patients with pancreatic ductal adenocarcinoma after resection? Findings High visceral-to-subcutaneous fat ratio is an independent predictor for early recurrence, whereas high skeletal muscle density and subcutaneous fat area independently predict better overall survival. Clinical relevance Combining body composition and clinicopathological indicators (carbohydrate antigen 19-9, carbohydrate antigen 12-5, tumor-node-metastasis stage, lymphovascular invasion, and adjuvant therapy) enables reliable prediction of postoperative prognosis in pancreatic ductal adenocarcinoma patients.