Journal Article

Prognostic value of early changes in CT-measured body composition in patients receiving chemotherapy for unresectable pancreatic cancer

Healy, Gerard M., Salinas-Miranda, Emmanuel, Gallinger, Steven, Dong, Xin, Haider, Masoom A., Knox, Jennifer, Deniffel, Dominik, O’Kane, Grainne M., Baracos, Vickie E., Bathe, Oliver F., Khalvati, Farzad

2021

Overview

Objectives Skeletal muscle mass is a prognostic factor in pancreatic ductal adenocarcinoma (PDAC). However, it remains unclear whether changes in body composition provide an incremental prognostic value to established risk factors, especially the Response Evaluation Criteria in Solid Tumors version 1.1 (RECISTv1.1). The aim of this study was to determine the prognostic value of CT-quantified body composition changes in patients with unresectable PDAC starting chemotherapy. Methods We retrospectively evaluated 105 patients with unresectable (locally advanced or metastatic) PDAC treated with FOLFIRINOX ( n = 64) or gemcitabine-based ( n = 41) first-line chemotherapy within a multicenter prospective trial. Changes (Δ) in skeletal muscle index (SMI), subcutaneous (SATI), and visceral adipose tissue index (VATI) between pre-chemotherapy and first follow-up CT were assessed. Cox regression models and covariate-adjusted survival curves were used to identify predictors of overall survival (OS). Results At multivariable analysis, adjusting for RECISTv1.1-response at first follow-up, ΔSMI was prognostic for OS with a hazard ratio (HR) of 1.2 (95% CI: 1.08–1.33, p = 0.001). No significant association with OS was observed for ΔSATI (HR: 1, 95% CI: 0.97–1.04, p = 0.88) and ΔVATI (HR: 1.01, 95% CI: 0.99–1.04, p = 0.33). At an optimal cutoff of 2.8 cm 2 /m 2 per 30 days, the median survival of patients with high versus low ΔSMI was 143 versus 233 days ( p < 0.001). Conclusions Patients with a lower rate of skeletal muscle loss at first follow-up demonstrated improved survival for unresectable PDAC, regardless of their RECISTv1.1-category. Assessing ΔSMI at the first follow-up CT may be useful for prognostication, in addition to routine radiological assessment. Key Points • In patients with unresectable pancreatic ductal adenocarcinoma, change of skeletal muscle index (ΔSMI) in the early phase of chemotherapy is prognostic for overall survival, even after adjusting for Response Evaluation Criteria in Solid Tumors version 1.1 (RECISTv1.1) assessment at first follow-up. • Changes in adipose tissue compartments at first follow-up demonstrated no significant association with overall survival. • Integrating ΔSMI into routine radiological assessment may improve prognostic stratification and impact treatment decision-making at the first follow-up.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Adenocarcinoma / Adipose tissue / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Body Composition / Cancer / Chemotherapy / Criteria / Decision making / Diagnostic Radiology / Evaluation / Gemcitabine / Hepatobiliary-Pancreas / Humans / Imaging / Internal Medicine / Interventional Radiology / Medical prognosis / Medicine / Medicine & Public Health / Metastases / Muscle, Skeletal - diagnostic imaging / Muscle, Skeletal - pathology / Muscles / Musculoskeletal system / Neuroradiology / Pancreatic cancer / Pancreatic Neoplasms - diagnostic imaging / Pancreatic Neoplasms - drug therapy / Pancreatic Neoplasms - pathology / Patients / Prognosis / Prospective Studies / Radiology / Regression analysis / Regression models / Retrospective Studies / Risk analysis / Risk factors / Sarcopenia / Sarcopenia - pathology / Skeletal muscle / Solid tumors / Survival / Tomography, X-Ray Computed / Tumors / Ultrasound