Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation
<i>Background</i>: Surgical resection offers the best chance of survival in patients with pancreatic cancer, but those with locally advanced disease (LAPC) are usually not surgical candidates. This cohort often receives either neoadjuvant chemotherapy or chemoradiation (CRT), but uninten...
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| Format: | Article |
| Language: | English |
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MDPI AG
2019-05-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/11/5/709 |
| _version_ | 1797713646204223488 |
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| author | Patrick Naumann Jonathan Eberlein Benjamin Farnia Thilo Hackert Jürgen Debus Stephanie E. Combs |
| author_facet | Patrick Naumann Jonathan Eberlein Benjamin Farnia Thilo Hackert Jürgen Debus Stephanie E. Combs |
| author_sort | Patrick Naumann |
| collection | DOAJ |
| description | <i>Background</i>: Surgical resection offers the best chance of survival in patients with pancreatic cancer, but those with locally advanced disease (LAPC) are usually not surgical candidates. This cohort often receives either neoadjuvant chemotherapy or chemoradiation (CRT), but unintended weight loss coupled with muscle wasting (sarcopenia) can often be observed. Here, we report on the predictive value of changes in weight and muscle mass in 147 consecutive patients with LAPC treated with neoadjuvant CRT. <i>Methods</i>: Clinicopathologic data were obtained via a retrospective chart review. The abdominal skeletal muscle area (SMA) at the third lumbar vertebral body was determined via computer tomographic (CT) scans as a surrogate for the muscle mass and skeletal muscle index (SMI) calculated. Uni- and multi-variable statistical tests were performed to assess for impact on survival. <i>Results</i>: Weight loss (14.5 vs. 20.3 months; <i>p</i> = 0.04) and loss of muscle mass (15.1 vs. 22.2 months; <i>p</i> = 0.007) were associated with poor outcomes. The highest survival was observed in patients who had neither cachectic weight loss nor sarcopenia (27 months), with improved survival seen in those who ultimately received a resection (23 vs. 10 months; <i>p</i> < 0.001). Cox regression revealed that either continued weight loss or continued muscle wasting (SMA reduction) was predictive of poor outcomes, whereas a sarcopenic SMI was not. <i>Conclusions</i>: Loss of weight and lean muscle in patients with LAPC is prognostic when persistent. Therefore, both should be assessed longitudinally and considered before surgery. |
| first_indexed | 2024-03-12T07:39:47Z |
| format | Article |
| id | doaj.art-c5f376d883554a28a3bbdff7fdf56973 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-12T07:39:47Z |
| publishDate | 2019-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-c5f376d883554a28a3bbdff7fdf569732023-09-02T21:22:20ZengMDPI AGCancers2072-66942019-05-0111570910.3390/cancers11050709cancers11050709Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with ChemoradiationPatrick Naumann0Jonathan Eberlein1Benjamin Farnia2Thilo Hackert3Jürgen Debus4Stephanie E. Combs5Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, GermanyDepartment of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, GermanyDepartment of Radiation Oncology, University of Miami, 1475 NW 12th Avenue, Suite 1500, Miami, FL 33136, USADepartment of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, GermanyDepartment of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, GermanyDepartment of Radiation Oncology, Technical University Munich (TUM), Ismaninger Straße 22, 81675 München, Germany<i>Background</i>: Surgical resection offers the best chance of survival in patients with pancreatic cancer, but those with locally advanced disease (LAPC) are usually not surgical candidates. This cohort often receives either neoadjuvant chemotherapy or chemoradiation (CRT), but unintended weight loss coupled with muscle wasting (sarcopenia) can often be observed. Here, we report on the predictive value of changes in weight and muscle mass in 147 consecutive patients with LAPC treated with neoadjuvant CRT. <i>Methods</i>: Clinicopathologic data were obtained via a retrospective chart review. The abdominal skeletal muscle area (SMA) at the third lumbar vertebral body was determined via computer tomographic (CT) scans as a surrogate for the muscle mass and skeletal muscle index (SMI) calculated. Uni- and multi-variable statistical tests were performed to assess for impact on survival. <i>Results</i>: Weight loss (14.5 vs. 20.3 months; <i>p</i> = 0.04) and loss of muscle mass (15.1 vs. 22.2 months; <i>p</i> = 0.007) were associated with poor outcomes. The highest survival was observed in patients who had neither cachectic weight loss nor sarcopenia (27 months), with improved survival seen in those who ultimately received a resection (23 vs. 10 months; <i>p</i> < 0.001). Cox regression revealed that either continued weight loss or continued muscle wasting (SMA reduction) was predictive of poor outcomes, whereas a sarcopenic SMI was not. <i>Conclusions</i>: Loss of weight and lean muscle in patients with LAPC is prognostic when persistent. Therefore, both should be assessed longitudinally and considered before surgery.https://www.mdpi.com/2072-6694/11/5/709locally advanced pancreatic cancerchemoradiationweight lossmuscle wastingbody compositionskeletal muscle indexsarcopeniacachexia |
| spellingShingle | Patrick Naumann Jonathan Eberlein Benjamin Farnia Thilo Hackert Jürgen Debus Stephanie E. Combs Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation Cancers locally advanced pancreatic cancer chemoradiation weight loss muscle wasting body composition skeletal muscle index sarcopenia cachexia |
| title | Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation |
| title_full | Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation |
| title_fullStr | Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation |
| title_full_unstemmed | Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation |
| title_short | Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation |
| title_sort | continued weight loss and sarcopenia predict poor outcomes in locally advanced pancreatic cancer treated with chemoradiation |
| topic | locally advanced pancreatic cancer chemoradiation weight loss muscle wasting body composition skeletal muscle index sarcopenia cachexia |
| url | https://www.mdpi.com/2072-6694/11/5/709 |
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