Rapid decline in visceral adipose tissue over 1 month is associated with poor prognosis in patients with unresectable pancreatic cancer

Abstract

Background Involuntary weight loss related to cachexia is common in patients with advanced cancer, but the association between body composition changes and survival is still unclear in pancreatic cancer. Methods We retrospectively reviewed the clinical outcomes of 55 patients with advanced pancreatic cancer undergoing palliative therapy or best supportive care (BSC). The skeletal muscle index (SMI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and visceral to subcutaneous adipose tissue area ratio (VSR) were calculated based on the cross‐sectional area on two sets of computed tomography images obtained at cancer diagnosis and 1 month later before treatment. The prognostic value of body composition indexes at diagnosis and the changes in those indexes over 1 month was then evaluated. Results In total, 45 patients (81.8%) received chemotherapy, chemoradiation, or radiation therapy, whereas the remaining patients underwent BSC. There were 27 patients (49.1%) who had low SMI at cancer diagnosis. Univariate analysis showed no significant associations between the baseline body composition indexes including SMI, VATI, SATI, and VSR and survival. Meanwhile, male sex (HR, 2.79; 95% CI, 1.16–6.71, p = 0.022) and higher decrease in VATI over 1 month (HR, 2.41; 95% CI, 1.13–5.13, p = 0.023) were identified as independent risk factors for mortality in multivariate analysis. Conclusion Rapid decline in VAT over 1 month is closely associated with poorer survival in unresectable advanced pancreatic cancer. A short‐term assessment of body composition changes may be a rational approach to predict prognosis in these patients.

Early skeletal muscle mass decline is a prognostic factor in patients receiving gemcitabine plus nab-paclitaxel for unresectable pancreatic cancer: a retrospective observational study

“…In our cohort, sarcopenia was observed in 44.2% at the time of diagnosis, which was similar to that of previous reports [7,16]. While some studies suggested association of sarcopenia at diagnosis with prognosis [12,14,25], others reported change in body composition was associated with survival [10][11][12]26]. Sarcopenia before chemotherapy was not associated with PFS or OS in our cohort, by using the criteria developed by the Hepatology Society of Japan based on the AWGS criteria (male SMI < 42 cm 2 /m 2 and female SMI < 38 cm 2 /m 2 ) [23].…”

“…Cancer cachexia is defined as a multifactorial syndrome defined by an ongoing loss of skeletal muscle mass that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment [8]. Recent studies suggested that loss of skeletal muscle mass was associated with cancer cachexia, which hindered continuance of chemotherapy, and can be one of prognostic factors of survival in PC [9][10][11][12][13]. However, it remains unclear whether sarcopenia at diagnosis or decline in skeletal muscle mass during chemotherapy is more prognostic of survival in PC, with various regimens such as FOLFIRINOX [14,15] and GnP [16] being evaluated.…”

Histomorphological and inflammatory changes of white adipose tissue in gastrointestinal cancer patients with and without cachexia

“…23 In addition, in a retrospective analysis, it was shown that a rapid decline in VAT over 30 days was related with poor outcomes (reduced survival) among patients affected by an unresectable pancreatic cancer. 24 This information highlights the clinical relevance of a short-term assessment of body composition analysis (changes in adiposity) in patients with gastrointestinal cancer that should guide physicians for an early nutritional intervention.…”

Evaluation of Browning Markers in Subcutaneous Adipose Tissue of Newly Diagnosed Gastrointestinal Cancer Patients with and without Cachexia

“…Recent clinical observations indicate that patients with advanced pancreatic cancer lose a large proportion of visceral and subcutaneous adipose tissue rapidly (approximately in 4 weeks), and this was associated with poor survival [37].…”