Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation

Abstract

Background: Surgical resection offers the best chance of survival in patients with pancreatic cancer, but those with locally advanced disease (LAPC) are usually not surgical candidates. This cohort often receives either neoadjuvant chemotherapy or chemoradiation (CRT), but unintended weight loss coupled with muscle wasting (sarcopenia) can often be observed. Here, we report on the predictive value of changes in weight and muscle mass in 147 consecutive patients with LAPC treated with neoadjuvant CRT. Methods: Clinicopathologic data were obtained via a retrospective chart review. The abdominal skeletal muscle area (SMA) at the third lumbar vertebral body was determined via computer tomographic (CT) scans as a surrogate for the muscle mass and skeletal muscle index (SMI) calculated. Uni- and multi-variable statistical tests were performed to assess for impact on survival. Results: Weight loss (14.5 vs. 20.3 months; p = 0.04) and loss of muscle mass (15.1 vs. 22.2 months; p = 0.007) were associated with poor outcomes. The highest survival was observed in patients who had neither cachectic weight loss nor sarcopenia (27 months), with improved survival seen in those who ultimately received a resection (23 vs. 10 months; p < 0.001). Cox regression revealed that either continued weight loss or continued muscle wasting (SMA reduction) was predictive of poor outcomes, whereas a sarcopenic SMI was not. Conclusions: Loss of weight and lean muscle in patients with LAPC is prognostic when persistent. Therefore, both should be assessed longitudinally and considered before surgery.

Identification of Potential Serum Protein Biomarkers and Pathways for Pancreatic Cancer Cachexia Using an Aptamer-Based Discovery Platform

“…Cachexia is a powerful predictor of mortality in pancreatic cancer. Patients with cachexia exhibit shorter overall survival after surgery for PDAC [ 7 ] and after neoadjuvant chemotherapy [ 8 ]. As well, among patients treated with folfirinox for PDAC, cachexia phenotype associates with reduced survival among patients with PDAC, even when controlling for demographics, cancer site, stage, and treatment response [ 9 ].…”

Cachectic Body Composition and Inflammatory Markers Portend a Poor Prognosis in Patients with Locally Advanced Pancreatic Cancer Treated with Chemoradiation

“…We previously reviewed evidence on the prognostic significance of continued weight loss and muscle depletion during CRT [25]; additional body composition markers such as subcutaneous fat, visceral fat, visceral obesity, sarcopenic visceral obesity as well as laboratory parameters associated with cachexia are the scope of the current retrospective analysis.…”

Identifying sarcopenia in advanced non‐small cell lung cancer patients using skeletal muscle CT radiomics and machine learning

“…This study had several limitations. First, we retrospectively assessed sarcopenia by muscle mass depletion analysis based on calculated L3-SMI, which is a routinely and widely used method, 13,20 and the absence of impaired muscle function could hinder the correct identification of sarcopenia; 31,32 however, additional prospective research will assist in solving this problem. Second, all the datasets herein were acquired from the same clinical center with the same PET/CT scanner.…”