Body Composition Impact on Survival and Toxicity of Treatment in Pancreatic Cancer: Cross-Sectional Pilot Study

Abstract

BACKGROUND: Weight loss and body composition changes are common in patients with pancreatic cancer. Computed tomography (CT) images are helpful to investigate body composition and its changes and to discriminate the different kinds of body tissues. Patients with pancreatic cancer routinely undergo CT scans. OBJECTIVE: To verify the association of muscle mass and visceral fat measured by CT with toxicity and survival of patients with pancreatic cancer. METHODS: We evaluated the imaging of the abdomen of all consecutive adult patients with pancreatic cancer treated between October 2007 and September 2015 in our service, to assess skeletal muscle mass and fat, intramuscular fat and visceral fat. We graded treatment toxicity symptoms according to the Common Toxicity Criteria of the United States National Cancer Institute (version 2.0). RESULTS: The study involved 17 patients, with a mean age of 63 (±10) years (range: 51-73 years). Eleven (65%) were male. The mean initial body mass index (BMI) was 26 kg/m2 (±3) and 23 kg/m2 (±3) after treatment. The mean weight loss was 10.0 kg (±6.8; 13%). Sarcopenia was present in 47% of patients, and it was not associated with significant differences in muscle mass, visceral fat, toxicity or survival. The mean skeletal muscle attenuation was 36 Hounsfield units, not associated with survival or treatment toxicity. Mean muscle mass was not associated with toxicity either. However, there was a significant inverse association between toxicity and visceral fat. CONCLUSION: Muscle mass had no impact on the survival or on treatment toxicity among the patients with pancreatic cancer. However, the visceral fat exerted a protective effect against the treatment toxicity. We stress the importance of further studies on visceral fat associated with prognosis and toxicity in cancer patients.

Body composition as a predictor of chemotherapy-related toxicity in pancreatic cancer patients: A systematic review

“…Among the 12 studies included, 1 was in the neo-adjuvant setting ( 31 ), 2 in the adjuvant setting ( 30 , 37 ), 3 in the metastatic setting ( 32 , 33 , 36 ); 2 in the unresectable setting ( 26 , 29 ); the other 4 included more than one clinical setting ( 22 , 34 , 35 , 38 ). Eight of the included studies were from Japan ( 22 , 26 , 29 – 32 , 34 , 35 ); 1 from South Korea ( 33 ); 1 from Canada ( 36 ); 1 from Brazil ( 37 ); 1 from Australia ( 38 ); all 12 studies were retrospective ( Table 1 ).…”

“…The Asian studies referred to cut-off values defined for the Asian population, but some used slightly lower cut-off values (26,29,30,34) than others (31)(32)(33). On the other hand, other studies (36)(37)(38) referred either to values elaborated in North America (43) or defined in post-hoc analyses (22). These discrepancies leave space for larger studies to define a proper definition for sarcopenia in PC patients, possibly according to ethnicity, in order to further assess whether an association between sarcopenia and chemorelated toxicity does exist.…”

“…The initial search yielded 1137 articles, all in English. According to inclusion and exclusion criteria, 12 full-text articles were included in this systematic review (22,26,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). Details about the literature search results are reported in Figure 1.…”

“…All the articles included evaluated the body composition values at the level of the third lumbar vertebra (L3); the software used was Slice-o-matic (Tomovision) in 5 studies (22,26,(36)(37)(38) and SYN-APSE Vincent in 7 studies (29)(30)(31)(32)(33)(34)(35). As shown in Table 3, body composition parameters evaluated were: SMI (derived from SMA) in 11/12 studies; VAT in 6/12 studies; SAT in 7/12 studies; SMD was evaluated in 3/12 articles; bone mineral density was never evaluated.…”

Body composition parameters predict survival in pancreatic cancer—A retrospective multicenter analysis

“…In the past, several body composition parameters have been examined, with contradicting results regarding their prognostic relevance. This was most likely due to heterogeneity of study populations, methods employed to analyze the data, cut‐offs used and clinical settings examined 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 Sarcopenia—a term used for low muscle mass—was associated with frailty, immobility and worse overall survival (OS) in PDAC patients. 8 , 9 , 10 , 11 , 15 , 16 , 17 , 18 , 20 , 22 The combination of sarcopenia with obesity (sarcopenic obesity) or visceral obesity (sarcopenic visceral obesity) demonstrated potential prognostic relevance in other types of cancer.…”