Clinical Nutrition · Nov 21, 2025

Both skeletal muscle index and muscle attenuation are associated with frailty in preoperative older patients with pancreatic cancer

By Lucassen CJ, Zügül Y, Droop A et al.

BACKGROUND AND AIMS: Frailty and sarcopenia are associated with morbidity and mortality in older patients with cancer. The aim of this study was to examine the association of frailty with skeletal muscle index (SMI) and muscle attenuation (MA) on preoperative CT-scans in older patients with pancreatic cancer. METHODS: A single-center retrospective study was performed in patients aged ≥70 years with pancreatic cancer. Frailty was assessed by an abbreviated GA screening. Preoperative SMI and MA were determined by computed tomography (CT) scan analysis. The association of frailty and individual frailty domains with SMI and MA was assessed using linear regression analyses. RESULTS: 101 patients were included of which 15 (14.9 %) were frail. Frailty was associated with lower SMI (adjusted β: -5.07 cm²/m²; 95 % CI: -8.77-1.36) and MA (adjusted β: -5.70 HU; 95 % CI: -9.63-1.77). Both impaired functionality and risk of delirium were associated with lower SMI (adjusted β: -7.01 cm²/m²; 95 % CI: -11.69-2.33 and adjusted β: -4.58 cm²/m²; 95 % CI: -8.22-0.95, respectively). Impaired functionality was also associated with lower MA (adjusted β: -6.88 HU; 95 % CI: -11.89-1.87). CONCLUSION: Frailty and impaired functionality were associated with lower SMI and MA. Risk of delirium was independently associated with lower SMI in preoperative older patients with pancreatic cancer. These results suggests that SMI and MA should be included in standard GA screening to better identify high-risk patients and enable more targeted treatment selection.

doi.org/10.1016/j.clnu.2025.11.004Open accessPubMed 41314111Biomarkers