The Association between Body Composition and Overall Survival of Advanced Stage Pancreatic Cancer Patients Treated with FOLFIRINOX

Abstract

Introduction: Pancreatic cancer (PC) is one of the most fatal malignancies, with a 5-year survival rate of less than 7%. Currently, the most effective chemotherapy regimen for PC is FOLFIRINOX. Body composition can influence chemotherapy toxicity and overall survival (OS). We investigated the prevalence and impact of cachexia and sarcopenia on outcome in patients with advanced stage PC treated with FOLFIRINOX. Methods: Of 66 patients studied, nine were excluded because they were eligible for resection after response following FOLFIRINOX. Skeletal muscle was analyzed using CT-scans at the third lumbar vertebra with Slice-O-Matic™ software and normalized for height (skeletal muscle index, SMI). Cachexia was defined according to the international consensus statement for cancer cachexia. Sarcopenia was defined using sex and BMI-specific cut-off points of SMI. The association between body composition parameters and complications as well as OS was evaluated. Results: Twenty-two locally advanced (LAPC) and 35 metastatic PC (MPC) patients were identified. Thirty (53%) patients were male and 27 (47%) were female. Thirteen (59%) LAPC patients, and 22 (63%) MPC patients were sarcopenic. For cachexia, this was 20 (91%) and 22 patients (63%), respectively. Sarcopenic LAPC patients experienced more CTCAE grade 3/4 complications (mean occurrence/cycle 0.57±0.36 vs. 0.29±0.34, p = 0.039). In metastatic disease, median OS was shorter for cachectic patients compared to non-cachectic patients (HR 7.23, 95%CI 4.82–9.64 vs. 8.03, 95%CI 0.00–17.38, p = 0.039). Multivariate analysis identified disease stage (HR 2.36, 95%CI 1.21–4.57, p = 0.06) and weight loss at diagnosis (HR 1.05, 95%CI 1.01–1.09, p = 0.02) as independent prognostic factors for survival in LAPC and MPC patients. Conclusion: Sarcopenia and cachexia were present in the majority of patients with advanced PC. Cachexia was associated with reduced overall survival in MPC patients and increased complications in LAPC patients. Body composition analysis may identify patients at risk for treatment complications and reduced overall survival.