| Crynodeb: | Background: We evaluated the prognostic value of Sarcopenia, low precardial adipose-tissue (PAT), and high tumor-volume in the outcome of surgically-treated pleural mesothelioma (PM). Methods: From 2005 to 2020, consecutive surgically-treated PM-patients having a pre-operative computed tomography (CT) scan were retrospectively included. Sarcopenia was assessed by CT-based parameters measured at the level of the fifth thoracic vertebra (TH5) by excluding fatty-infiltration based on CT-attenuation. The findings were stratified for gender, and a threshold of the 33rd percentile was set to define sarcopenia. Additionally, tumor volume as well as PAT were measured. The findings were correlated with progression-free survival and long-term mortality. Results: Two-hundred-seventy-eight PM-patients (252 male; 70.2 ± 9 years) were included. The mean progression-free survival was 18.6 ± 12.2 months, and the mean survival time was 23.3 ± 24 months. Progression was associated with chronic obstructive pulmonary disease (COPD) (<i>p</i> = <0.001), tumor-stage (<i>p</i> = 0.001), and type of surgery (<i>p</i> = 0.026). Three-year mortality was associated with higher patient age (<i>p</i> = 0.005), presence of COPD (<i>p</i> < 0.001), higher tumor-stage (<i>p</i> = 0.015), and higher tumor-volume (<i>p</i> < 0.001). Kaplan-Meier statistics showed that sarcopenic patients have a higher three-year mortality (<i>p</i> = 0.002). While there was a negative correlation of progression-free survival and mortality with tumor volume (r = 0.281, <i>p</i> = 0.001 and r = −0.240, <i>p</i> < 0.001; respectively), a correlation with PAT could only be shown for epithelioid PM (<i>p</i> = 0.040). Conclusions: Sarcopenia as well as tumor volume are associated with long-term mortality in surgically treated PM-patients. Further, while there was a negative correlation of progression-free survival and mortality with tumor volume, a correlation with PAT could only be shown for epithelioid PM.
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