Abstract
IntroductionBody composition has emerged as a prognostic factor in cancer patients. We investigated whether sarcopenia at diagnosis and loss of skeletal muscle during palliative chemotherapy were associated with survival in patients with pancreatic cancer.MethodsWe retrospectively reviewed the clinical outcomes of pancreatic cancer patients receiving palliative chemotherapy between 2003 and 2010. The cross-sectional area of skeletal muscle at L3 by computed tomography was analyzed with Rapidia 3D software. We defined sarcopenia as a skeletal muscle index (SMI)< 42.2 cm2/m2 (male) and < 33.9 cm2/m2 (female) using ROC curve.ResultsAmong 484 patients, 103 (21.3%) patients were sarcopenic at diagnosis. Decrease in SMI during chemotherapy was observed in 156 (60.9%) male and 65 (40.6%) female patients. Decrease in body mass index (BMI) was observed in 149 patients (37.3%), with no gender difference. By multivariate analysis, sarcopenia (P< 0.001), decreasedBMI and SMI during chemotherapy (P = 0.002, P = 0.004, respectively) were poor prognostic factors for overall survival (OS). While the OS of male patients was affected with sarcopenia (P< 0.001) and decreased SMI (P = 0.001), the OS of female patients was influenced with overweight at diagnosis (P = 0.006), decreased BMI (P = 0.032) and decreased SMI (P = 0.014). Particularly, while the change of BMI during chemotherapy did not have impact on OS within the patients with maintained SMI (P = 0.750), decrease in SMI was associated with poor OS within the patients with maintained BMI (HR 1.502; P = 0.002).ConclusionsSarcopenia at diagnosis and depletion of skeletal muscle, independent of BMI change, during chemotherapy were poor prognostic factors in advanced pancreatic cancer.
Highlights
MethodsWe retrospectively reviewed the clinical outcomes of pancreatic cancer patients receiving palliative chemotherapy between 2003 and 2010
Body composition has emerged as a prognostic factor in cancer patients
While the overall survival (OS) of male patients was affected with sarcopenia (P< 0.001) and decreased skeletal muscle index (SMI) (P = 0.001), the OS of female patients was influenced with overweight at diagnosis (P = 0.006), decreased body mass index (BMI) (P = 0.032) and decreased SMI (P = 0.014)
Summary
We retrospectively reviewed the clinical outcomes of pancreatic cancer patients receiving palliative chemotherapy between 2003 and 2010. The cross-sectional area of skeletal muscle at L3 by computed tomography was analyzed with Rapidia 3D software. We defined sarcopenia as a skeletal muscle index (SMI)< 42.2 cm2/m2 (male) and < 33.9 cm2/m2 (female) using ROC curve. We assessed all the patients with histologically confirmed pancreatic cancer (PC) who received palliative chemotherapy at Seoul National University Hospital between January 2003 and December 2012. Those without computed tomography (CT) scans that included the third lumbar (L3) level within 30 days before starting the first cycle of chemotherapy were excluded. Change in body weight was determined asthe difference in the weight between atdiagnosis and at the cessation of first-line chemotherapy because of progression. Patients were categorized according to initial BMI into 3 groups, as follows:
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