Surgical Outcomes and Postoperative Changes in Nutritional Indexes and Sarcopenia Markers in Oldest-old Patients With Resected Biliary Tract Cancer: A Retrospective Cohort Study

Background/Aim: Biliary tract cancer is treated through surgical resection, but the risk of recurrence remains high. Identifying preoperative prognostic factors may allow better risk–benefit assessment and patient stratification for more effective treatment. This study aimed to evaluate the prognostic significance of sarcopenia and systemic inflammatory markers in oldest-old patients with resected biliary tract cancer.

Patients and Methods: We retrospectively reviewed 160 patients with resected biliary tract cancer between July 2010 and December 2023. Myopenia and myosteatosis, indicated by intramuscular adipose tissue content/modified intramuscular adipose tissue content, were measured preoperatively using computed tomography. We analyzed the associations between clinicopathological characteristics and overall survival using Cox proportional hazards models.

Results: Univariate analysis showed that a low prognostic nutritional index (<42), low modified intramuscular adipose tissue content, and lymph node metastasis were associated with worse overall survival in patients aged ≥85 years (n=19). A low prognostic nutritional index (p=0.027) and lymph node metastasis (p=0.018) were identified as independent predictors of overall survival in the multivariate analysis. Changes in nutritional and sarcopenia markers were comparable between the oldest-old and younger patients after surgery.

Conclusion: Preoperative low prognostic nutritional index and lymph node metastasis were reported as independent prognostic factors for overall survival in oldest-old patients with resected biliary tract cancer.