Prognostic Factors for Risk Stratification of Patients with Recurrent or Metastatic Pancreatic Adenocarcinoma Who Were Treated with Gemcitabine-Based Chemotherapy

Abstract

PurposeThe aim of this study was to verify prognostic factors including sarcopenia in patients with recurrent or metastatic pancreatic cancer receiving gemcitabine-based chemotherapy.Materials and MethodsMedical records and computed tomography scan of consecutive patients treated with palliative gemcitabine-based chemotherapy from 2008 to 2014 were reviewed. The lumbar skeletal muscle index at third lumbar spine level was computed, and together with clinicolaboratory factors, univariate and multivariable analyses for overall survival (OS) were performed.ResultsA total of 88 patients were found. Median age was 65 years, and male patients were predominant (67.0%). Most patients had initially metastatic disease (72.7%), and gemcitabine monotherapy was administered in 29 patients (33.0%) while gemcitabine plus erlotinib was administered in 59 patients (67.0%). Seventy-six patients (86.3%) had sarcopenia. With a median follow-up period of 44.3 months (range, 0.6 to 44.3 months), median OS was 5.35 months (95% confidence interval [CI], 4.11 to 6.59). In univariate and multivariable analysis, high carcinoembryonic antigen level (hazard ratio [HR], 4.18; 95% CI, 1.95 to 8.97; p < 0.001), initially metastatic disease (HR, 3.37; 95% CI, 1.55 to 7.32; p=0.002), sarcopenia (HR, 2.97; 95% CI, 1.20 to 7.36; p=0.019), neutrophilia (HR, 2.94; 95% CI, 1.27 to 6.79; p=0.012), and high lactate dehydrogenase level (HR, 1.96; 95% CI, 1.07 to 3.58; p=0.029) were identified as independent prognostic factors for OS.ConclusionFive independent prognostic factors in patients with recurrent or metastatic pancreatic cancer who received gemcitabine-based chemotherapy were identified. These findings may be helpful in prediction of prognosis in clinical practice and can be used as a stratification factor for clinical trials.

Effect of pretreatment psoas muscle mass on survival for patients with unresectable pancreatic cancer undergoing systemic chemotherapy

“…However, as aforementioned, few reports have addressed this important clinical question in patients with unresectable APC who are receiving systemic chemotherapy (24,25). The present study was, therefore, conducted.…”

“…However, to the best of our knowledge, there are few reports regarding the impact of DSMM on survival in patients with unresectable APC undergoing systemic chemotherapy (24,25). Therefore, it is imperative to address these issues.…”

Decreased Skeletal Muscle Mass After Neoadjuvant Therapy Correlates with Poor Prognosis in Patients with Esophageal Cancer

“…Sarcopenia is characterized by degenerative loss of skeletal muscle mass and strength. Loss of skeletal muscle has been identified as predictive of a poor prognosis in patients with many benign and malignant lesions, including liver cirrhosis (5), chronic obstructive pulmonary disease (6), lung cancer (7), cholangiocarcinoma (8), hepatocellular carcinoma (9), metastatic renal cell carcinoma (10), pancreatic cancer (11), colorectal cancer (12), melanoma (13), breast cancer (14), and diffuse large B-cell lymphoma (15), among others. In patients with ESCC without lymphnode involvement, skeletal muscle loss is associated with reduced overall survival (16), as well as postoperative respiratory complications, anastomotic insufficiency and toxicity during neoadjuvant chemotherapy (NAC) (16)(17)(18).…”

Assessment of muscle mass with computerised tomography in patients with incurable gastrointestinal cancer. A prospective single centre study

“…Patients with incurable cancer often develop alterations in body composition, which has a negative impact on prognosis [1,2]. The change in body composition in cancer patients often includes loss of muscle mass associated with functional disability and mortality [3][4][5].…”