CORRELATION BETWEEN BODY COMPOSITION, INFLAMMATION AND SURVIVAL IN PANCREATIC CANCER TREATED WITH NEOADJUVANT THERAPY

Abstract

To evaluate the association between body composition (BC) and systemic inflammatory response (SIR) following neoadjuvant treatment (NAD), and to explore their impact on long-term outcome in pancreatic ductal adenocarcinoma (PDAC) pts. Non-consecutive PDAC pts undergoing surgical exploration after NAD with available CT-scans (both at diagnosis and preoperatively) at two academic medical institutions from 2013 to 2015 were evaluated. BC was assessed by analyzing L3 CT-scan images before and after NAD. Neutrophil-lymphocyte ratio (NLR) was as a marker for SIR. Data were correlated with OS using Cox model. Kaplan-Meier curves were compared with Log-Rank test. The study population consisted of 108 pts (males: 56.5%), with a median follow-up of 16 months. 91 pts (89.8%) received FOLFIRINOX. BC changed significantly during NAD: total and visceral adipose tissue decreased (p<0.001), whereas the lean mass was increased (p<0.001). Sarcopenia was found in 45 pts (41.7%). Moreover, an NLR ≥ 3 was common (58.3%) and significantly related to total adipose and muscle tissue (p=0.032, p=0.002, respectively). Univariate analyses showed that age (HR 1.02, p=0.016), resection (HR 3.77, p=0.001), baseline skeletal mass normalized for height (TAMA) (HR 1.02, p=0.004) and increase in TAMA during NAD (HR 0.98, p=0.035) significantly affected OS. At MVA, age (HR 2.52, p=0.12) and baseline TAMA (HR 4.36, p=0.001) were significant independent predictors for OS. Our data provide evidence that BC impacts on long-term outcome in PDAC pts submitted to NAD. In addition, our results suggest a strict correlation between host SIR and changes in BC during and after NAD.