University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
J Pain Symptom Manage. 2012 Aug;44(2):181-91. doi: 10.1016/j.jpainsymman.2011.09.010. Epub 2012 Jun 12.
In pancreatic cancer, the presence of obesity or weight loss is associated with higher mortality.
To explore the relationships among body mass index, longitudinal body composition alterations, and clinical outcomes in pancreatic cancer patients.
Records of 41 patients with inoperable locally advanced pancreatic cancer who participated in a prospective chemoradiation study were reviewed. Body composition was analyzed from two sets of computed tomography images obtained before and after radiation treatment (median interval 104 days).
Median age was 59 years and 56% of patients were female. Twenty-four (59%) patients were either overweight (22%) or obese (37%). Sarcopenia was present in 26 (63%) patients. At follow-up, weight loss was experienced by 33 (81%) patients. The median losses (%) before and after treatment were weight 5% (P<0.001), skeletal muscle (SKM) 4% (P=0.003), visceral adipose tissue (VAT) 13% (P<0.001), and subcutaneous adipose tissue 11% (P=0.002). SKM loss positively correlated with age (P=0.03), baseline body mass index (P<0.001), and VAT (P=0.04) index. Obese patients experienced higher losses in weight (P=0.009), SKM (P=0.02), and VAT (P=0.02). Median survival was 12 months. In univariate analysis, age, baseline obesity, sarcopenic obesity, and losses (%) in weight, SKM, and VAT were associated with worse survival. In multivariate analysis, only age (hazard ratio=1.033, P=0.04) and higher VAT loss (hazard ratio=2.6 and P=0.03) remained significant.
Our preliminary findings suggest that obese patients experience higher losses in weight, SKM, and VAT, which may contribute to poorer survival in these patients.
在胰腺癌中，肥胖或体重减轻与更高的死亡率相关。
探索身体质量指数（BMI）、纵向身体成分变化与不能手术的局部晚期胰腺癌患者临床结局之间的关系。
回顾了 41 例参与前瞻性放化疗研究的不能手术的局部晚期胰腺癌患者的记录。在放射治疗前后（中位间隔 104 天）获得的两组计算机断层扫描图像中分析身体成分。
中位年龄为 59 岁，56%的患者为女性。24 例（59%）患者超重（22%）或肥胖（37%）。26 例（63%）患者存在肌肉减少症。随访时，33 例（81%）患者经历了体重下降。治疗前后的体重中位数损失（%）分别为体重 5%（P<0.001）、骨骼肌（SKM）4%（P=0.003）、内脏脂肪组织（VAT）13%（P<0.001）和皮下脂肪组织 11%（P=0.002）。SKM 损失与年龄（P=0.03）、基线 BMI（P<0.001）和 VAT 指数（P=0.04）呈正相关。肥胖患者体重（P=0.009）、SKM（P=0.02）和 VAT（P=0.02）的损失更高。中位生存期为 12 个月。在单因素分析中，年龄、基线肥胖、肌肉减少性肥胖以及体重、SKM 和 VAT 的损失（%）与生存较差相关。在多因素分析中，仅年龄（危险比=1.033，P=0.04）和更高的 VAT 损失（危险比=2.6，P=0.03）仍有意义。
我们的初步研究结果表明，肥胖患者体重、SKM 和 VAT 的损失更高，这可能导致这些患者的生存更差。
