Prognostic values of abdominal body compositions on survival in advanced pancreatic cancer

Bian, Xiaojie; Dai, Hanjue; Feng, Jun; Ji, Hongxia; Fang, Yuting; Jiang, Nan; Wei, Li

doi:10.1097/md.0000000000010988

Cited by 26 publications

(28 citation statements)

References 22 publications

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“…A high VFR represents a high amount of intraabdominal fat tissue (VFA) in relation to the subcutaneous fat tissue (SFA). This finding of a prognostic impact of high VFR aligns with other studies conducted with pancreatic cancer patients [ 34 , 35 ] or lung cancer patients [ 9 ], where a high VFR turned out to be a predictor of poor prognosis. This prognostic impact seems to be consistent across several cancer entities.…”

Section: Discussionsupporting

confidence: 90%

Impact of progressive resistance training on CT quantified muscle and adipose tissue compartments in pancreatic cancer patients

et al. 2020

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Objectives Loss of body weight is often seen in pancreatic cancer and also predicts poor prognosis. Thus, maintaining muscle mass is an essential treatment goal. The primary aim was to investigate whether progressive resistance training impacts muscle and adipose tissue compartments. Furthermore, the effect of body composition on overall survival (OS) was investigated. Methods In the randomized SUPPORT-study, 65 patients were assigned to 6-month resistance training (2x/week) or a usual care control group. As secondary endpoint, muscle strength of the upper and lower extremities was assessed before and after the intervention period. Routine CT scans were assessed on lumbar L3/4 level for quantification of total-fat-area, visceral-fat-area, subcutaneous-fat-area, intramuscular-fat-area, visceral-to-subcutaneous fat ratio (VFR), muscle-area (MA), muscle-density and skeletal-muscle-index (SMI). OS data were retrieved. Results Of 65 patients, 53 had suitable CT scans at baseline and 28 completed the intervention period with suitable CT scans. There were no significant effects observed of resistance training on body composition (p>0.05; effect sizes ω2p <0.02). Significant moderate to high correlations were found between MA and muscle strength parameters (r = 0.57–0.85; p<0.001). High VFR at baseline was a predictor of poor OS (VFR≥1.3 vs. <1.3; median OS 14.6 vs. 45.3 months; p = 0.012). Loss of muscle mass was also a predictor of poor OS (loss vs. gain of SMI; median OS 24.6 vs. 50.8 months; p = 0.049). Conclusion There is anabolic potential in patients with resectable pancreatic cancer. A progressive resistance training may help patients to maintain their muscle mass and avoid muscle depletion. CT-quantified muscle mass at the level of L3/4 showed a good correlation to muscle strength. Therefore, maintaining muscle mass and muscle strength through structured resistance training could help patients to maintain their physical functioning. A high VFR at baseline and a high loss of muscle mass are predictors of poor OS. Registered on ClinicalTrials.gov (NCT01977066).

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Section: Discussionsupporting

confidence: 90%

Impact of progressive resistance training on CT quantified muscle and adipose tissue compartments in pancreatic cancer patients

et al. 2020

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“…Body fat primarily consists of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT), which are not only located in two distinct compartments, but also have different metabolic activities and impact on disease progression 7 . Meanwhile, the prognostic value of SAT and VAT remains a subject of debate in many types of cancer 3,4,6,8–12 …”

Section: Introductionmentioning

confidence: 99%

Rapid decline in visceral adipose tissue over 1 month is associated with poor prognosis in patients with unresectable pancreatic cancer

et al. 2021

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Background Involuntary weight loss related to cachexia is common in patients with advanced cancer, but the association between body composition changes and survival is still unclear in pancreatic cancer. Methods We retrospectively reviewed the clinical outcomes of 55 patients with advanced pancreatic cancer undergoing palliative therapy or best supportive care (BSC). The skeletal muscle index (SMI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and visceral to subcutaneous adipose tissue area ratio (VSR) were calculated based on the cross‐sectional area on two sets of computed tomography images obtained at cancer diagnosis and 1 month later before treatment. The prognostic value of body composition indexes at diagnosis and the changes in those indexes over 1 month was then evaluated. Results In total, 45 patients (81.8%) received chemotherapy, chemoradiation, or radiation therapy, whereas the remaining patients underwent BSC. There were 27 patients (49.1%) who had low SMI at cancer diagnosis. Univariate analysis showed no significant associations between the baseline body composition indexes including SMI, VATI, SATI, and VSR and survival. Meanwhile, male sex (HR, 2.79; 95% CI, 1.16–6.71, p = 0.022) and higher decrease in VATI over 1 month (HR, 2.41; 95% CI, 1.13–5.13, p = 0.023) were identified as independent risk factors for mortality in multivariate analysis. Conclusion Rapid decline in VAT over 1 month is closely associated with poorer survival in unresectable advanced pancreatic cancer. A short‐term assessment of body composition changes may be a rational approach to predict prognosis in these patients.

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“…Computed tomography (CT) scan has been used to measure visceral fat area (VFA) and subcutaneous fat area (SFA), and the ratio of VFA/SFA (VSR) as indicators of visceral obesity. In various solid malignancies, it has been suggested that visceral obesity is associated with worse outcomes [6-10]. However, to our knowledge, there is no study evaluating visceral obesity as a prognostic factor in lung cancer.…”

Section: Introductionmentioning

confidence: 99%

Low Body Mass Index Is an Independent Prognostic Factor in Patients With Non-Small Cell Lung Cancer Treated With Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor

et al. 2019

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BackgroundSarcopenia and obesity have been suspected as factors associated with efficacy of treatment and prognosis in various malignancies. This study aimed to investigate the association of pretreatment sarcopenia and visceral obesity with efficacy and prognosis of first- and second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) for patients with non-small cell lung cancer (NSCLC) and positive EGFR mutation.MethodsWe retrospectively collected 167 NSCLC patients with mutant EGFR who had started EGFR-TKI monotherapy between October 2007 and August 2018 at our hospital. We classified 167 patients into two groups, according to the definition of underweight based on the World Health Organization (WHO) body mass index (BMI) classification and the Japanese sex-specific cut-off values of the following computed tomography (CT) images-assessed markers of pretreatment sarcopenia or visceral obesity, such as psoas muscle index (PMI), intramuscular adipose tissue content (IMAC) and visceral-to-subcutaneous fat ratio (VSR) at lumbar vertebra L3 level. We compared overall survival (OS) and progression-free survival (PFS) of two groups by Kaplan-Meier curves and log-rank tests. Using multivariate Cox proportional hazard analyses adjusted by age, neutrophil-to-lymphocyte ratio, performance status, EGFR mutation types and EGFR-TKI lines, and extra-pulmonary metastases or three or more than 3 metastatic sites, we searched independent prognostic factors of OS and PFS of EGFR-TKI therapy.ResultsThe OS (median 26.0 vs. 32.3 months, P = 0.02) and PFS (9.1 vs. 14.8 months, P = 0.03) of patients with BMI < 18.5 were significantly shorter than those of patients with BMI ≥ 18.5. However, there was no significant difference in OS and PFS according to PMI, IMAC and VSR. The multivariate analyses detected only BMI < 18.5 as an unfavorable prognostic factor of shorter OS (hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.03 - 2.81, P = 0.04) and PFS (HR 1.72, 95% CI 1.11 - 2.67, P = 0.02).ConclusionsPretreatment underweight was a significant prognostic factor of poor PFS and OS of EGFR-TKI therapy. However, neither pretreatment sarcopenia nor visceral obesity was associated with prognosis of EGFR-TKI. Underweight may be a surrogate for advanced disease burden.

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Prognostic values of abdominal body compositions on survival in advanced pancreatic cancer

Cited by 26 publications

References 22 publications

Impact of progressive resistance training on CT quantified muscle and adipose tissue compartments in pancreatic cancer patients

Impact of progressive resistance training on CT quantified muscle and adipose tissue compartments in pancreatic cancer patients

Rapid decline in visceral adipose tissue over 1 month is associated with poor prognosis in patients with unresectable pancreatic cancer

Low Body Mass Index Is an Independent Prognostic Factor in Patients With Non-Small Cell Lung Cancer Treated With Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor

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