HPB P15 A retrospective cohort study investigating the progression of sarcopenia and its impact on outcomes in patients with pancreatic cancer undergoing neoadjuvant chemotherapy

Abstract

Abstract Background Pancreatic ductal adenocarcinoma (PDAC) is a devastating disease, with surgical resection providing the best chance of survival. However, many patients are not eligible for surgery. Neoadjuvant therapy (NAT) offers the potential to downsize the disease to enable resection for patients with borderline resectable (BR) or locally advanced (LA) PDAC. This study aims to assess changes in body composition during NAT, in particular, the progression of sarcopenia, and how this impacts outcomes in these patients. Methods This is a retrospective cohort study including 65 patients with BR or LA-PDAC who underwent NAT between January 2017 and December 2020. Routine baseline and post-NAT computed tomography scans were analysed for changes in sarcopenia and adiposity measurements. The impact of these changes on chance of resection and overall survival was assessed. Additionally, the effect of pancreatic enzyme replacement therapy (PERT) on these changes and outcomes was investigated. Results Muscle mass and adiposity decreased during NAT (p<0.05). 42% received resection following NAT. Those who were still not eligible for resection experienced greater reductions in muscle mass (-0.84cm2/m2 vs - 0.36cm2/m2, p=0.005) and subcutaneous adipose (-43.3cm2 vs -19.7cm2, p=0.033). Changes in body composition were not independently associated with overall survival. Patients receiving PERT experienced less reduction in muscle mass (-0.41cm2/m2 vs -0.82cm2/m2, p=0.0009). Conclusions This study suggests that there is progression of sarcopenia and a reduction in adiposity during NAT, which could preclude surgical resection of PDAC. PERT may reduce the progression of sarcopenia. Larger studies in this field are required to draw reliable conclusions.