为了评估CT基于标志物对肌肉萎缩和肌内脂肪沉积的预后价值，与东部合作肿瘤学组（ECOG）评分对接受高强度聚焦超声治疗的晚期胰腺癌患者的生存情况进行比较。对于142名回顾性患者，在介入前的CT上确定上肠系膜动脉水平的骨骼肌指数（SMI），骨骼肌放射密度（SMRD），脂肪肌肉比例（FMF）和肌间脂肪比例（IMFF）。每个标志物与性别，年龄，体重指数（BMI）和ECOG进行相关性分析。使用Kaplan-Meier分析和log-rank检验以及单变量和多变量Cox比例风险（CPH）模型研究标志物的预后价值。观察到以下显著相关性：男性患者BMI和SMI较高。ECOG较低的患者BMI和SMI较低。BMI低于21.8 kg/m2（中位数）的患者还显示SMI和IMFF较低。年龄低于63.3岁（中位数）的患者SMRD较高，FMF较低和IMFF较低。在Kaplan-Meier分析中，ECOG较高或SMI较低的患者显示显著较短的生存时间。在单变量CPH分析中，ECOG较高、BMI较低和SMI较低与1、2和3年生存期间的患者风险增加有关。多变量1年生存期的CPH分析显示ECOG较高、SMI较低、IMFF较低和FMF较高与患者风险增加相关。在2年和3年生存期的多变量分析中，只有ECOG和FMF仍然显著。CT基于肌肉萎缩和肌内脂肪沉积的标志物在评估接受HIFU治疗的晚期胰腺癌患者的生存情况方面具有预后价值。结果表明，在临床评分之外，肌肉脂肪沉积标志物FMF对长期生存与ECOG的多变量CPH分析独立，显示了额外的风险评估作用。• 本研究调查了CT基于肌肉萎缩和肌内脂肪沉积标志物对接受高强度聚焦超声治疗的胰腺癌患者的预后价值。• 肌肉萎缩和肌内脂肪沉积标志物除了根据东部合作肿瘤学组分数进行的体检评估之外，还显示了预后价值。与肌肉大小测量相比，肌肉脂肪沉积标志物FMF与临床评分独立。• 结果表明，肌内脂肪沉积可能在额外的患者风险评估中起着更大的作用，超出了体检评估的范畴。

To evaluate the prognostic value of CT-based markers of sarcopenia and myosteatosis in comparison to the Eastern Cooperative Oncology Group (ECOG) score for survival of patients with advanced pancreatic cancer treated with high-intensity focused ultrasound (HIFU).For 142 retrospective patients, the skeletal muscle index (SMI), skeletal muscle radiodensity (SMRD), fatty muscle fraction (FMF), and intermuscular fat fraction (IMFF) were determined on superior mesenteric artery level in pre-interventional CT. Each marker was tested for associations with sex, age, body mass index (BMI), and ECOG. The prognostic value of the markers was examined in Kaplan-Meier analyses with the log-rank test and in uni- and multivariable Cox proportional hazards (CPH) models.The following significant associations were observed: Male patients had higher BMI and SMI. Patients with lower ECOG had lower BMI and SMI. Patients with BMI lower than 21.8 kg/m2 (median) also showed lower SMI and IMFF. Patients younger than 63.3 years (median) were found to have higher SMRD, lower FMF, and lower IMFF. In the Kaplan-Meier analysis, significantly lower survival times were observed in patients with higher ECOG or lower SMI. Increased patient risk was observed for higher ECOG, lower BMI, and lower SMI in univariable CPH analyses for 1-, 2-, and 3-year survival. Multivariable CPH analysis for 1-year survival revealed increased patient risk for higher ECOG, lower SMI, lower IMFF, and higher FMF. In multivariable analysis for 2- and 3-year survival, only ECOG and FMF remained significant.CT-based markers of sarcopenia and myosteatosis show a prognostic value for assessment of survival in advanced pancreatic cancer patients undergoing HIFU therapy.The results indicate a greater role of myosteatosis for additional risk assessment beyond clinical scores, as only FMF was associated with long-term survival in multivariable CPH analyses along ECOG and also showed independence to ECOG in group analysis.• This study investigates the prognostic value of CT-based markers of sarcopenia and myosteatosis for patients with pancreatic cancer treated with high-intensity focused ultrasound. • Markers for sarcopenia and myosteatosis showed a prognostic value besides clinical assessment of the physical status by the Eastern Cooperative Oncology Group score. In contrast to muscle size measurements, the myosteatosis marker fatty muscle fraction demonstrated independence to the clinical score. • The results indicate that myosteatosis might play a greater role for additional patient risk assessments beyond clinical assessments of physical status.© 2023. The Author(s).