Prognostic impact of osteosarcopenia on postoperative outcomes in patients with biliary tract cancer

Frailty, characterized by sarcopenia and osteopenia, is associated with poor survival after the resection of biliary tract cancer (BTC). Osteosarcopenia, the coexistence of sarcopenia and osteopenia, has recently been associated with poor outcomes in various cancers. This study assessed the prognostic value of osteosarcopenia after the resection of BTC.

We analyzed 109 patients who underwent BTC resection between 2014 and 2021 for the following conditions: intrahepatic cholangiocarcinoma (n = 21), perihilar cholangiocarcinoma (n = 16), distal cholangiocarcinoma (n = 32), gallbladder carcinoma (n = 17), and ampullary carcinoma (n = 23). Sarcopenia was evaluated using computed tomography of the psoas muscle at the third lumbar vertebra, while osteopenia was measured using bone mineral density at the 11th thoracic vertebra. Osteosarcopenia was defined as the presence of both the conditions.

Sarcopenia was present in 54 patients (50%), osteopenia in 50 patients (46%), and osteosarcopenia in 30 patients (28%). Lymph node metastasis is common in patients with osteosarcopenia. A multivariate analysis revealed that lymph node metastasis (p = 0.0278), poor tumor differentiation (p = 0.0027), and osteosarcopenia (p = 0.0436) were independent predictors of poor disease-free survival. Osteosarcopenia was also a significant predictor of poor overall survival (p < 0.0001).

Osteosarcopenia serves as a prognostic factor for poor outcomes after BTC resection.