Serum Biomarkers and CT-Derived Muscle Indices in Sarcopenia Associated with Pancreatic Neoplasm: A Comparative Clinical Study
Costel-George Gherghescu, Radu Andrei Baz, Constantin Dina, Eugen Dumitru, Georgeta Camelia Cozaru, Mihaela Manea, Ioana Popescu, Ana-Maria Grigorescu, Stere Popescu, Andrei DumitruOriginal article, no. 2, 2026
Article DOI: 10.21614/chirurgia.3291
Background: Sarcopenia is a frequent and clinically relevant condition in patients with pancreatic neoplasm, contributing to poor prognosis, reduced therapeutic tolerance, and increased mortality. The identification of reliable circulating biomarkers, alongside imaging-based muscle assessment, may improve early detection and risk stratification.
Methods: This randomized prospective study included 61 patients, of whom 36 had pancreatic neoplasm associated with sarcopenia and 25 served as controls. Serum levels of osteonectin (SPARC), C-terminal agrin fragment (CAF), procollagen type III N-terminal peptide (P3NP), myostatin (MSTN), and insulin-like growth factor-1 (IGF-1) were measured using ELISA. Skeletal muscle index (SMI) and psoas muscle index (PMI) were assessed using CT at the L3 level.
Results: Patients with pancreatic neoplasm and sarcopenia showed significantly altered biomarker profiles compared to controls. Osteonectin (median 936.4 vs. 539.9, p 0.001), CAF (2135.9 vs. 1165.5, p 0.001), P3NP (8.01 vs. 5.34, p 0.001), myostatin (47.71 vs. 7.85, p 0.001), and IGF-1 (142 vs. 106.7, p 0.001) were all elevated. The highest biomarker levels were consistently observed in the pancreatic neoplasm group compared to other disease groups. Additionally, 100% of patients with pancreatic neoplasm exhibited reduced SMI, confirming the high prevalence of sarcopenia. Biomarker levels were not significantly influenced by tumor location.
Conclusions: The combined use of circulating biomarkers and CT-derived muscle indices provides a clinically relevant approach for identifying sarcopenia in pancreatic cancer.
Methods: This randomized prospective study included 61 patients, of whom 36 had pancreatic neoplasm associated with sarcopenia and 25 served as controls. Serum levels of osteonectin (SPARC), C-terminal agrin fragment (CAF), procollagen type III N-terminal peptide (P3NP), myostatin (MSTN), and insulin-like growth factor-1 (IGF-1) were measured using ELISA. Skeletal muscle index (SMI) and psoas muscle index (PMI) were assessed using CT at the L3 level.
Results: Patients with pancreatic neoplasm and sarcopenia showed significantly altered biomarker profiles compared to controls. Osteonectin (median 936.4 vs. 539.9, p 0.001), CAF (2135.9 vs. 1165.5, p 0.001), P3NP (8.01 vs. 5.34, p 0.001), myostatin (47.71 vs. 7.85, p 0.001), and IGF-1 (142 vs. 106.7, p 0.001) were all elevated. The highest biomarker levels were consistently observed in the pancreatic neoplasm group compared to other disease groups. Additionally, 100% of patients with pancreatic neoplasm exhibited reduced SMI, confirming the high prevalence of sarcopenia. Biomarker levels were not significantly influenced by tumor location.
Conclusions: The combined use of circulating biomarkers and CT-derived muscle indices provides a clinically relevant approach for identifying sarcopenia in pancreatic cancer.
Keywords: sarcopenia, pancreatic neoplasm, biomarkers, osteonectin, CAF, P3NP, myostatin, IGF-1, computed tomography, skeletal muscle index
