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Characterising the impact of body composition change during neoadjuvant chemotherapy for pancreatic cancer.
Pancreatology. 2019 Sep; 19(6):850-857.P

Abstract

BACKGROUND

Pancreatic Cancer remains a lethal disease for the majority of patients. New chemotherapy agents such as Folfirinox offer therapeutic potential for patients who present with Borderline Resectable disease (BRPC). However, results to date are inconsistent, with factors such as malnutrition limiting successful drug delivery. We sought to determine the prevalence of sarcopenia in BRPC patients at diagnosis, and to quantify body composition change during chemotherapy.

METHODS

The diagnostic/restaging CT scans of BRPC patients were analysed. Body composition was measured at L3 using Tomovision Slice-O-Matic™. Total muscle and adipose tissue mass were estimated using validated regression equations. Sarcopenia was defined as per gender- and body mass index (BMI)-specific lumbar skeletal muscle index (LSMI) and muscle attenuation reference values.

RESULTS

Seventy-eight patients received neo-adjuvant chemotherapy, and 67 patients underwent restaging CT, at which point a third were deemed resectable. Half were sarcopenic at diagnosis, and sarcopenia was equally prevalent across all BMI categories.. Skeletal muscle and adipose tissue (intra-muscular, visceral and sub-cutaneous) area decreased during chemotherapy (p < 0.0001). Low muscle attenuation was observed in half of patients at diagnosis, and was associated with increased mortality risk. Loss of lean tissue parameters during chemotherapy was associated with an increased mortality risk; specifically fat-free mass, HR 1.1 (95% CI 1.03-1.17, p = 0.003) and skeletal muscle mass, HR 1.21 (95%CI 1.08-1.35, p = 0.001).

CONCLUSIONS

Sarcopenia was prevalent in half of patients at the time of diagnosis with BRPC. Low muscle attenuation at diagnosis, coupled with lean tissue loss during chemotherapy, independently increased mortality risk.

Authors+Show Affiliations

Professorial Surgical Unit, Trinity College Dublin, Trinity Centre for Health Science, Tallaght, Dublin 24, Ireland; National Surgical Centre for Pancreatic Cancer, St Vincent's University Hospital, Dublin 24, Ireland. Electronic address: griffino@tcd.ie.Professorial Surgical Unit, Trinity College Dublin, Trinity Centre for Health Science, Tallaght, Dublin 24, Ireland.Department of Radiology, St Vincent's University Hospital, Dublin 24, Ireland.Department of Medical Oncology, St Vincent's University Hospital, Dublin 24, Ireland.National Surgical Centre for Pancreatic Cancer, St Vincent's University Hospital, Dublin 24, Ireland.Professorial Surgical Unit, Trinity College Dublin, Trinity Centre for Health Science, Tallaght, Dublin 24, Ireland; National Surgical Centre for Pancreatic Cancer, St Vincent's University Hospital, Dublin 24, Ireland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31362865

Citation

Griffin, Oonagh M., et al. "Characterising the Impact of Body Composition Change During Neoadjuvant Chemotherapy for Pancreatic Cancer." Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], vol. 19, no. 6, 2019, pp. 850-857.
Griffin OM, Duggan SN, Ryan R, et al. Characterising the impact of body composition change during neoadjuvant chemotherapy for pancreatic cancer. Pancreatology. 2019;19(6):850-857.
Griffin, O. M., Duggan, S. N., Ryan, R., McDermott, R., Geoghegan, J., & Conlon, K. C. (2019). Characterising the impact of body composition change during neoadjuvant chemotherapy for pancreatic cancer. Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], 19(6), 850-857. https://doi.org/10.1016/j.pan.2019.07.039
Griffin OM, et al. Characterising the Impact of Body Composition Change During Neoadjuvant Chemotherapy for Pancreatic Cancer. Pancreatology. 2019;19(6):850-857. PubMed PMID: 31362865.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characterising the impact of body composition change during neoadjuvant chemotherapy for pancreatic cancer. AU - Griffin,Oonagh M, AU - Duggan,Sinead N, AU - Ryan,Ronan, AU - McDermott,Raymond, AU - Geoghegan,Justin, AU - Conlon,Kevin C, Y1 - 2019/07/24/ PY - 2019/04/11/received PY - 2019/07/07/revised PY - 2019/07/23/accepted PY - 2019/8/1/pubmed PY - 2020/2/25/medline PY - 2019/8/1/entrez KW - Cancer cachexia KW - Pancreatic cancer KW - Sarcopenia SP - 850 EP - 857 JF - Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] JO - Pancreatology VL - 19 IS - 6 N2 - BACKGROUND: Pancreatic Cancer remains a lethal disease for the majority of patients. New chemotherapy agents such as Folfirinox offer therapeutic potential for patients who present with Borderline Resectable disease (BRPC). However, results to date are inconsistent, with factors such as malnutrition limiting successful drug delivery. We sought to determine the prevalence of sarcopenia in BRPC patients at diagnosis, and to quantify body composition change during chemotherapy. METHODS: The diagnostic/restaging CT scans of BRPC patients were analysed. Body composition was measured at L3 using Tomovision Slice-O-Matic™. Total muscle and adipose tissue mass were estimated using validated regression equations. Sarcopenia was defined as per gender- and body mass index (BMI)-specific lumbar skeletal muscle index (LSMI) and muscle attenuation reference values. RESULTS: Seventy-eight patients received neo-adjuvant chemotherapy, and 67 patients underwent restaging CT, at which point a third were deemed resectable. Half were sarcopenic at diagnosis, and sarcopenia was equally prevalent across all BMI categories.. Skeletal muscle and adipose tissue (intra-muscular, visceral and sub-cutaneous) area decreased during chemotherapy (p < 0.0001). Low muscle attenuation was observed in half of patients at diagnosis, and was associated with increased mortality risk. Loss of lean tissue parameters during chemotherapy was associated with an increased mortality risk; specifically fat-free mass, HR 1.1 (95% CI 1.03-1.17, p = 0.003) and skeletal muscle mass, HR 1.21 (95%CI 1.08-1.35, p = 0.001). CONCLUSIONS: Sarcopenia was prevalent in half of patients at the time of diagnosis with BRPC. Low muscle attenuation at diagnosis, coupled with lean tissue loss during chemotherapy, independently increased mortality risk. SN - 1424-3911 UR - https://www.unboundmedicine.com/medline/citation/31362865/Characterising_the_impact_of_body_composition_change_during_neoadjuvant_chemotherapy_for_pancreatic_cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1424-3903(19)30670-2 DB - PRIME DP - Unbound Medicine ER -