Sarcopenia in an Overweight or Obese Patient Is an Adverse Prognostic Factor in Pancreatic Cancer

Abstract

Purpose: The average weight-losing pancreatic cancer patient undergoing palliative therapy is frequently overweight rather than underweight, and this can confound conventional measures used for risk stratification. The aim of this study was to evaluate if weight and body composition, specifically sarcopenia, assessed from diagnostic computed tomography (CT) scans, is of prognostic value in patients with pancreatic cancer. The nature and extent of tissue loss over subsequent months was also evaluated. Experimental Design: A total of 111 patients entering a palliative therapy program, who had CT images and had undergone nutritional screening, were studied. In patients for whom follow-up scans were available (n = 44), longitudinal changes in body composition were studied at a mean of 230 ± 62 and 95 ± 60 days prior to demise. Results: Sixty-two patients (55.9%) were sarcopenic, 44 (39.6%) were overweight/ obese, and 18 (16.2%) were both. Age ≥59 years (hazard ratio, 1.71; 95% confidence interval, 1.10-2.66; P = 0.018), and overweight/obese sarcopenia (hazard ratio, 2.07; 95% confidence interval, 1.23-3.50; P = 0.006) were identified as independent predictors of survival on multivariate analysis. Longitudinal analysis revealed that total fat-free mass index decreased from 15.5 ± 2.5 kg/m 2 to 14.5 ± 2.0 kg/m 2 (P = 0.002), and total fat mass index decreased from 7.5 ± 2.0kg/m 2 to 6.0 ± 1.5kg/m 2 (P < 0.0001) over 135 days. Conclusions: Sarcopenia in overweight/obese patients with advanced pancreatic cancer is an occult condition but can be identified using CT scans. This condition is an independent adverse prognostic indicator that should be considered for stratification of patients' entering clinical trials, systemic therapy, or support care programs. (Clin Cancer Res 2009;15(22):6973-9) Pancreatic cancer is the fourth leading cause of cancer-related death in Western countries (1). At the time of diagnosis, tumor resection with curative intent is only possible in 10% to 15% of subjects (2, 3), leaving a large population with poor prognosis and limited therapeutic options. Overall, the 5-year survival rate is only about 4% (4).One of the most distressing features of pancreatic cancer is marked and progressive weight loss. Cachexia occurs in up to 80% of deaths in patients with advanced pancreatic cancer (5). Cachexia has been shown to worsen prognosis and has also been associated with impairment of physical function, increased psychological distress, and low quality of life (6, 7). Patients with pancreatic cancer often report a decreased dietary intake and many symptoms such as anorexia, early satiety, anxiety, depression, pain, and nausea (8).Due to the epidemic of obesity in Western society, a substantial proportion of oncology patients at the start of palliative therapy now have a body mass index (BMI) in the overweight range (9), and this can confound conventional measures used for risk stratification. Indeed recent studies have reported that obesity (i.e., BMI ≥30 kg/m 2

Impact of sarcopenia in borderline resectable and locally advanced pancreatic cancer patients receiving stereotactic body radiation therapy

“…While TPA and BSA could significantly predict the development of acute radiation complications, BMI could not. BMI has been found to be a useful metric in outcomes related to obesity, and rarely has it found usefulness for low BMI (24,60). When dealing with a patient population that is generally underweight, we found no significant role for BMI regarding our selected outcomes.…”

Skeletal muscle loss after total gastrectomy, exacerbated by adjuvant chemotherapy

“…CT scan is the gold standard for quantifying skeletal muscle mass [22], and Mourtzakis et al [18] have shown that the CT cross sectional area at L3 is strongly related to appendicular skeletal mass, a common index of sarcopenia as measured by dual-energy X-ray densitometry. CT cross-sectional area at L3 single slice was employed in many studies as a reliable method to evaluate body composition [7,10,23]. In our study, mean SMI (cm 2 /m 2 ) decreased from 46.6 to 43.6 by 1 year after surgery and ATI (cm 2 /m 2 ) decreased from 76.4 to 21.4; these declines corresponded to 6.2 % and 65.8 % reductions of the preoperative values, respectively ( Table 2).…”

“…It leads to nosocomial infections [3], postoperative complications [4][5][6][7], increased length of hospital stay [7,8], and decreased survival in nonmalignant as well as malignant populations [9][10][11][12].…”

Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy

“…Recently, the influence of sarcopenia on treatment outcomes in cancer patients has been intensively investigated; sarcopenia was demonstrated to be independently associated with negative short-term [11][12][13][14][15][16][17][18] and long-term [11,[18][19][20] outcomes after surgery and an increased rate of chemotherapy-related toxicity [21][22][23].…”