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Abstract

Purpose:

To investigate the prognostic impact of sarcopenia on the survival of patients with locally advanced pancreatic cancer (LAPC) treated with concurrent chemoradiotherapy (CCRT).

Methods:

We retrospectively reviewed 299 patients diagnosed with LAPC and treated with definitive CCRT from 2000 to 2015. Skeletal muscle index (SMI) was measured using computed tomography scans and sarcopenia was defined as SMI <29.6 cm²/m² for women and <36.2 cm²/m² for men. The significance of sarcopenia for progression-free survival (PFS) and overall survival (OS) was evaluated.

Results:

Sarcopenia was present in 29 patients (9.7%). In multivariate analysis, sarcopenia was a significant factor for PFS (p = 0.043). Although sarcopenia was not a significant factor for OS (p = 0.121) in multivariate analysis, long-term survivors were observed only in the no sarcopenia group (OS at 60 months: 9.5% vs 0%, p < 0.001).

Conclusion:

In patients undergoing CCRT for LAPC, sarcopenia is an independent factor for adverse prognosis.

Keywords

Pancreatic cancer sarcopenia radiotherapy

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References

Torre

Bray

Siegel

, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65: 87–108.

Ryan

Hong

Bardeesy

. Pancreatic adenocarcinoma. N Engl J Med 2014; 371: 2140–2141.

Rosenberg

. Sarcopenia: origins and clinical relevance. J Nutr 1997; 127: 990S–991S.

Borggreve

den Boer

van Boxel

, et al. The predictive value of low muscle mass as measured on CT scans for postoperative complications and mortality in gastric cancer patients: a systematic review and meta-analysis. J Clin Med 2020; 9.

Zhang

Tan

Jiang

, et al. Sarcopenia as a predictor of poor surgical and oncologic outcomes after abdominal surgery for digestive tract cancer: a prospective cohort study. Clin Nutr 2019; 38: 2881–2888.

Shinohara

Otsuki

Kobayashi

, et al. Impact of sarcopenia on surgical outcomes in non-small cell lung cancer. Ann Surg Oncol 27: 2427–2435.

Bachmann

Buchler

Friess

, et al. Cachexia in patients with chronic pancreatitis and pancreatic cancer: impact on survival and outcome. Nutr Cancer 2013; 65: 827–833.

Dewys

Begg

Lavin

, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients: Eastern Cooperative Oncology Group. Am J Med 1980; 69: 491–497.

Ozola Zalite

Zykus

Francisco Gonzalez

, et al. Influence of cachexia and sarcopenia on survival in pancreatic ductal adenocarcinoma: a systematic review. Pancreatology 2015; 15: 19–24.

10.

Gruber

Jomrich

Tamandl

, et al. Sarcopenia and sarcopenic obesity are independent adverse prognostic factors in resectable pancreatic ductal adenocarcinoma. PLoS One 2019; 14: e0215915.

11.

Ratnayake

Loveday

Shrikhande

, et al. Impact of preoperative sarcopenia on postoperative outcomes following pancreatic resection: a systematic review and meta-analysis. Pancreatology 2018; 18: 996–1004.

12.

Kang

Jeong

Baik

, et al. Impact of sarcopenia on prognostic value of cirrhosis: going beyond the hepatic venous pressure gradient and MELD score. J Cachexia Sarcopenia Muscle 2018; 9: 860–870.

13.

Fujiwara

Nakagawa

Kudo

, et al. Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma. J Hepatol 2015; 63: 131–140.

14.

Cruz-Jentoft

Baeyens

Bauer

, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39: 412–423.

15.

Tewari

Awad

Macdonald

, et al. A comparison of three methods to assess body composition. Nutrition 2018; 47: 1–5.

16.

Cesari

Vellas

. Sarcopenia: a novel clinical condition or still a matter for research? J Am Med Dir Assoc 2012; 13: 766–767.

17.

Tan

Birdsell

Martin

, et al. Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. Clin Cancer Res 2009; 15: 6973–6979.

18.

Kurita

Kobayashi

Tokuhisa

, et al. Sarcopenia is a reliable prognostic factor in patients with advanced pancreatic cancer receiving FOLFIRINOX chemotherapy. Pancreatology 2019; 19: 127–135.

19.

Mintziras

Miligkos

Wachter

, et al. Sarcopenia and sarcopenic obesity are significantly associated with poorer overall survival in patients with pancreatic cancer: systematic review and meta-analysis. Int J Surg 2018; 59: 19–26.

20.

Neto

NIP

Murari

ASP

Oyama

, et al. Peritumoural adipose tissue pro-inflammatory cytokines are associated with tumoural growth factors in cancer cachexia patients. J Cachexia Sarcopenia Muscle 2018; 9: 1101–1108.

21.

Matsunaga

Miyata

Sugimura

, et al. Prognostic significance of sarcopenia and systemic inflammatory response in patients with esophageal cancer. Anticancer Res 2019; 39: 449–458.

22.

Feliciano

EMC

Kroenke

Meyerhardt

, et al. Association of systemic inflammation and sarcopenia with survival in nonmetastatic colorectal cancer: results from the C SCANS Study. JAMA Oncol 2017; 3: e172319.

23.

Hammel

Huguet

van Laethem

, et al. Effect of chemoradiotherapy vs chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: the LAP07 randomized clinical trial. JAMA 2016; 315: 1844–1853.

24.

Murphy

Ryan

, et al. Total neoadjuvant therapy with FOLFIRINOX in combination with losartan followed by chemoradiotherapy for locally advanced pancreatic cancer: a phase 2 clinical trial. JAMA Oncol 2019; 5: 1020–1027.

25.

Chung

Chang

Lee

, et al. Dose escalation in locally advanced pancreatic cancer patients receiving chemoradiotherapy. Radiother Oncol 2017; 123: 438–445.

26.

Hiroshima

Fukumitsu

Saito

, et al. Concurrent chemoradiotherapy using proton beams for unresectable locally advanced pancreatic cancer. Radiother Oncol 2019; 136: 37–43.

27.

Shinoto

Terashima

Suefuji

, et al. A single institutional experience of combined carbon-ion radiotherapy and chemotherapy for unresectable locally advanced pancreatic cancer. Radiother Oncol 2018; 129: 333–339.

28.

Prado

Purcell

Laviano

. Nutrition interventions to treat low muscle mass in cancer. J Cachexia Sarcopenia Muscle 2020; 11: 366–380.

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Impact of sarcopenia on survival of pancreatic cancer patients treated with concurrent chemoradiotherapy