{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T15:40:48Z","timestamp":1791819648221,"version":"4.3.4"},"reference-count":56,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,10,26]],"date-time":"2016-10-26T00:00:00Z","timestamp":1477440000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Netherlands Organization for Scientific Research","award":["NWO Grant 022.003.011"],"award-info":[{"award-number":["NWO Grant 022.003.011"]}]},{"name":"Alpe d'HuZes Foundation of the Dutch Cancer Society","award":["UM-2012-5633"],"award-info":[{"award-number":["UM-2012-5633"]}]},{"name":"Kankeronderzoekfonds Limburg","award":["00005739"],"award-info":[{"award-number":["00005739"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cancer cachexia and skeletal muscle wasting are related to poor survival. In this study, quantitative body composition measurements using computed tomography (CT) were investigated in relation to survival, post\u2010operative complications, and surgical site infections in surgical patients with cancer of the head of the pancreas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective cohort of 199 patients with cancer of the head of the pancreas was analysed by CT imaging at the L3 level to determine (i) muscle radiation attenuation (average Hounsfield units of total L3 skeletal muscle); (ii) visceral adipose tissue area; (iii) subcutaneous adipose tissue area; (iv) intermuscular adipose tissue area; and (v) skeletal muscle area. Sex\u2010specific cut\u2010offs were determined at the lower tertile for muscle radiation attenuation and skeletal muscle area and the higher tertile for adipose tissues. These variables of body composition were related to overall survival, severe post\u2010operative complications (Dindo\u2013Clavien\u2009\u2265\u20093), and surgical site infections (wounds inspected daily by an independent trial nurse) using Cox\u2010regression analysis and multivariable logistic regression analysis, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Low muscle radiation attenuation was associated with shorter survival in comparison with moderate and high muscle radiation attenuation [median survival 10.8 (95% CI: 8.8\u201312.8) vs. 17.4 (95% CI: 14.7\u201320.1), and 18.5 (95% CI: 9.2\u201327.8) months, respectively;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.008]. Patient subgroups with high muscle radiation attenuation combined with either low visceral adipose tissue or age &lt;70\u2009years had longer survival than other subgroups (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.011 and\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001, respectively). Muscle radiation attenuation was inversely correlated with intermuscular adipose tissue (\n                      <jats:italic>r<\/jats:italic>\n                      <jats:sub>p<\/jats:sub>\n                      \u2009=\u2009\u22120.697,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). High visceral adipose tissue was associated with an increased surgical site infection rate, OR: 2.4 (95% CI: 1.1\u20135.3;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.027).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Low muscle radiation attenuation was associated with reduced survival, and high visceral adiposity was associated with an increase in surgical site infections. The strong correlation between muscle radiation attenuation and intermuscular adipose tissue suggests the presence of ectopic fat in muscle, warranting further investigation. CT image analysis could be implemented in pre\u2010operative risk assessment to assist in treatment decision\u2010making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.12155","type":"journal-article","created":{"date-parts":[[2016,10,27]],"date-time":"2016-10-27T00:08:53Z","timestamp":1477526933000},"page":"317-326","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":220,"title":["Low skeletal muscle radiation attenuation and visceral adiposity are associated with overall survival and surgical site infections in patients with pancreatic cancer"],"prefix":"10.1002","volume":"8","author":[{"given":"David P. J.","family":"van Dijk","sequence":"first","affiliation":[{"name":"Department of Surgery Maastricht University Medical Centre Maastricht The Netherlands"},{"name":"NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht University Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maikel J. A. M.","family":"Bakens","sequence":"additional","affiliation":[{"name":"Department of Surgery Maastricht University Medical Centre Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari\u00eblle M. E.","family":"Coolsen","sequence":"additional","affiliation":[{"name":"Department of Surgery Maastricht University Medical Centre Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander S.","family":"Rensen","sequence":"additional","affiliation":[{"name":"Department of Surgery Maastricht University Medical Centre Maastricht The Netherlands"},{"name":"NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht University Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald M.","family":"van Dam","sequence":"additional","affiliation":[{"name":"Department of Surgery Maastricht University Medical Centre Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn J. L.","family":"Bours","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Maastricht University Maastricht The Netherlands"},{"name":"GROW School for Oncology and Developmental Biology Maastricht University Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matty P.","family":"Weijenberg","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Maastricht University Maastricht The Netherlands"},{"name":"GROW School for Oncology and Developmental Biology Maastricht University Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelis H. 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