Department of Surgery, University of Chicago Medical Center, Chicago, IL, United States.
Section of Geriatrics & Palliative Medicine, University of Chicago Medical Center, Chicago, IL, United States.
J Geriatr Oncol. 2018 Jul;9(4):367-372. doi: 10.1016/j.jgo.2018.03.002. Epub 2018 Mar 10.
Sarcopenia is associated with poor outcomes in patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC). However, few studies have assessed changes in sarcopenia during multimodality therapy or its effect on overall survival (OS).
Computed tomography (CT) total psoas area index (TPAI) and weighted average Hounsfield units (HU) were measured at each treatment interval in patients with resectable PDAC. Four cohorts were compared: 1. Neoadjuvant chemotherapy plus surgery plus adjuvant chemotherapy ("NSA"; n = 20); 2. surgery plus adjuvant chemotherapy ("SA"; n = 20); 3. neoadjuvant chemotherapy with intent to perform surgery ("Chemotherapy"; n = 24); and 4. treated with palliative intent ("Palliative"; n = 21).
Fifty-nine deaths were identified. Median OS was 15.7 months (95% Confidence Interval (CI) 12.7-20.2). Patients who underwent surgery had a higher OS (p < 0.001), with the SA group having a longer OS than the NSA group. Cox regression models identified baseline TPAI (Hazard Ratio (HR) = 0.82; p = 0.04), but not psoas HU, as a significant predictor of OS. The mean decrease in TPAI following neoadjuvant chemotherapy was 0.6 cm2/m2 (p < 0.001; 95% CI -0.8--0.3) and the mean decrease in HU was 2.7 (p = 0.04, 95% CI -5.4--0.1). For patients who underwent surgery (NSA and SA cohorts), a decrease in TPAI was associated with worse OS (HR 0.52; p = 0.05). In contrast, decreased HU was associated with worse OS in patients who did not undergo surgery (HR 0.93; p = 0.01).
In patients who received neoadjuvant chemotherapy, there was a significant decrease in TPAI and HU during treatment. Prospective studies are warranted to assess the impact of TPAI loss and HU changes on clinical outcomes to better individualize treatment pathways based on a patient's fitness.
骨骼肌减少症与接受胰腺导管腺癌（PDAC）手术治疗的患者预后不良有关。然而，很少有研究评估在多模式治疗过程中骨骼肌减少症的变化及其对总生存期（OS）的影响。
在可切除 PDAC 患者的每个治疗间隔测量计算机断层扫描（CT）总腰大肌面积指数（TPAI）和加权平均亨氏单位（HU）。比较了四个队列：1. 新辅助化疗加手术加辅助化疗（“NSA”；n=20）；2. 手术加辅助化疗（“SA”；n=20）；3. 新辅助化疗意向手术（“化疗”；n=24）；4. 姑息治疗（“姑息”；n=21）。
共确定了 59 例死亡。中位 OS 为 15.7 个月（95%置信区间（CI）12.7-20.2）。接受手术的患者 OS 更高（p<0.001），SA 组的 OS 长于 NSA 组。Cox 回归模型确定基线 TPAI（风险比（HR）=0.82；p=0.04），但不是腰大肌 HU，是 OS 的显著预测因子。新辅助化疗后 TPAI 的平均下降为 0.6cm2/m2（p<0.001；95%CI-0.8--0.3），HU 的平均下降为 2.7（p=0.04，95%CI-5.4--0.1）。对于接受手术的患者（NSA 和 SA 队列），TPAI 的下降与 OS 更差相关（HR 0.52；p=0.05）。相比之下，未接受手术的患者 HU 下降与 OS 更差相关（HR 0.93；p=0.01）。
在接受新辅助化疗的患者中，治疗过程中 TPAI 和 HU 显著下降。需要进行前瞻性研究评估 TPAI 丧失和 HU 变化对临床结果的影响，以便根据患者的健康状况更好地个体化治疗途径。
