Skeletal Muscle Loss and Octogenarian Status Are Associated with S-1 Adjuvant Therapy Discontinuation and Poor Prognosis after Pancreatectomy

Abstract

The efficacy and prognosis of adjuvant chemotherapy for resected pancreatic cancer remain unclear. We investigated the utility and risk factors of S-1 adjuvant chemotherapy in patients with pancreatic cancer undergoing pancreatectomy. This study comprised 80 patients, including 58 patients who received S-1 adjuvant chemotherapy. Skeletal muscle loss was defined using cutoff values of skeletal muscle mass index. In total, 16 (20%) octogenarian patients underwent pancreatectomy. Skeletal muscle loss was present in 56 (70%) patients. The entire course of S-1 adjuvant chemotherapy for 6 months was completed in 33 patients (41%). S-1 adjuvant chemotherapy <6 months was an independent prognostic indicator of poor overall survival. Patients who completed S-1 adjuvant chemotherapy exhibited significantly longer overall and relapse-free survival rates than those did not complete the chemotherapy (p <0.0001 and p = 0.0003, respectively). Being an octogenarian and skeletal muscle loss were independent variables associated with the discontinuation of S-1 adjuvant chemotherapy. Finally, the S-1 adjuvant chemotherapy rates were 6.3% (1/16) and 28.6% (16/56) in octogenarian patients and those with skeletal muscle loss, respectively. S-1 adjuvant chemotherapy completion was associated with improved prognosis in patients with pancreatic cancer. Skeletal muscle loss and octogenarian status predicted the failure of S-1 adjuvant chemotherapy completion.

Body composition as a predictor of chemotherapy-related toxicity in pancreatic cancer patients: A systematic review

“…Among the 12 studies included, 1 was in the neo-adjuvant setting ( 31 ), 2 in the adjuvant setting ( 30 , 37 ), 3 in the metastatic setting ( 32 , 33 , 36 ); 2 in the unresectable setting ( 26 , 29 ); the other 4 included more than one clinical setting ( 22 , 34 , 35 , 38 ). Eight of the included studies were from Japan ( 22 , 26 , 29 – 32 , 34 , 35 ); 1 from South Korea ( 33 ); 1 from Canada ( 36 ); 1 from Brazil ( 37 ); 1 from Australia ( 38 ); all 12 studies were retrospective ( Table 1 ).…”

“…Among the trials including gemcitabine, 2/9 demonstrated an association with toxicity, whereas 7/9 did not; among those including FOLFIRINOX, one demonstrated associated toxicity whereas the others did not. Altogether, 4/12 papers demonstrated an association between the body composition values and the development of chemotherapy-related toxicities (1 between low SMI and hematological toxicity and reduction of cycles number ( 29 ); 1 between loss of skeletal muscle and discontinuation of chemotherapy ( 30 ); 1 between low SMI and low SMD with all grade 3 toxicities ( 33 ); 1 with hematological toxicity ( 22 )). Associations of body composition values and chemo-related toxicities are summarized in Table 3 .…”

“…Associations of body composition values and chemo-related toxicities are summarized in Table 3 . Among the included articles, only 3/12 performed a specific analysis for older patients, with 2/3 study reporting no association between age and the advent of chemotherapy-related toxicity ( 26 , 29 ), 1/3 reporting a significant association of chemo-related toxicity for octuagenarian patients ( 30 ).…”

“…The initial search yielded 1137 articles, all in English. According to inclusion and exclusion criteria, 12 full-text articles were included in this systematic review (22,26,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). Details about the literature search results are reported in Figure 1.…”

“…All the articles included evaluated the body composition values at the level of the third lumbar vertebra (L3); the software used was Slice-o-matic (Tomovision) in 5 studies (22,26,(36)(37)(38) and SYN-APSE Vincent in 7 studies (29)(30)(31)(32)(33)(34)(35). As shown in Table 3, body composition parameters evaluated were: SMI (derived from SMA) in 11/12 studies; VAT in 6/12 studies; SAT in 7/12 studies; SMD was evaluated in 3/12 articles; bone mineral density was never evaluated.…”