Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Surgery, School of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
JAMA Surg. 2018 Sep 1;153(9):809-815. doi: 10.1001/jamasurg.2018.0979.
Sarcopenia and sarcopenic obesity have been associated with poor outcomes in unresectable pancreatic cancer (PC). Neoadjuvant treatment (NT) is used increasingly to improve resectability; however, its effects on fat and muscle body composition have not been characterized.
To evaluate whether NT affects muscle mass and adipose tissue in patients with borderline resectable PC (BRPC) and locally advanced PC (LAPC) and determine whether there were potential differences between patients who ultimately underwent resection and those who did not.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study conducted at 4 academic medical centers, 193 patients with BRPC and LAPC undergoing surgical exploration after NT who had available computed tomographic scans (both at diagnosis and preoperatively) and confirmed pancreatic ductal adenocarcinoma were evaluated. The study was conducted from January 2013 to December 2015. Data analysis was performed from September 2016 to May 2017. Measurement of body compartments was evaluated with volume assessment software before and after NT. A radiologist blinded to the patient outcome assessed the areas of skeletal muscle, total adipose tissue, and visceral adipose tissue through a standardized protocol.
Receipt of NT.
Achievement of pancreatic resection at surgical exploration after the receipt of NT.
Of the 193 patients with complete radiologic imaging available after NT, 96 (49.7%) were women; mean (SD) age at diagnosis was 64 (11) years. Most patients received combined therapy with fluorouracil, irinotecan, oxaliplatin, leucovorin, and folic acid (124 [64.2%]) and 86 (44.6%) received chemoradiotherapy as well. The median interval between pre-NT and post-NT imaging was 6 months (interquartile range [IQR], 4-7 months). All body compartments significantly changed. The adipose compound decreased (median total adipose tissue area from 284.0 cm2; IQR, 171.0-414.0 to 250.0 cm2; IQR, 139.0-363.0; P < .001; median visceral adipose tissue area from 115.2 cm2; IQR, 59.9-191.0 to 97.7 cm2; IQR, 48.0-149.0 cm2; P < .001), whereas the lean mass slightly improved (median skeletal muscle from 122.1 cm2; IQR, 99.3-142.0 to 123 cm2; IQR 104.8-152.5 cm2; P = .001). Surgical resection was achievable in 136 (70.5%) patients. Patients who underwent resection had experienced a 5.9% skeletal muscle area increase during NT treatment, whereas those who did not undergo resection had a 1.7% decrease (P < .001).
Patients with PC experience a significant loss of adipose tissue during neoadjuvant chemotherapy, but no muscle wasting. An increase in muscle tissue during NT is associated with resectability.
肌肉减少症和肌肉减少性肥胖症与不可切除的胰腺癌（PC）的不良预后有关。新辅助治疗（NT）越来越多地用于提高可切除性；然而，其对脂肪和肌肉身体成分的影响尚未得到描述。
评估 NT 是否会影响边界可切除 PC（BRPC）和局部晚期 PC（LAPC）患者的肌肉质量和脂肪组织，并确定最终接受切除术和未接受切除术的患者之间是否存在潜在差异。
设计、地点和参与者：这项在 4 家学术医疗中心进行的回顾性队列研究纳入了 193 名接受 NT 后接受手术探查的 BRPC 和 LAPC 患者，这些患者有可获得的计算机断层扫描（均在诊断时和术前）和确诊的胰腺导管腺癌。该研究于 2013 年 1 月至 2015 年 12 月进行。数据分析于 2016 年 9 月至 2017 年 5 月进行。在 NT 前后使用体积评估软件评估身体隔室的测量。一位对患者结果不知情的放射科医生通过标准化协议评估骨骼肌、总脂肪组织和内脏脂肪组织的区域。
接受 NT。
在接受 NT 后手术探查时实现胰腺切除术。
在接受 NT 后可获得完整影像学的 193 名患者中，96 名（49.7%）为女性；诊断时的平均（SD）年龄为 64（11）岁。大多数患者接受了氟尿嘧啶、伊立替康、奥沙利铂、亚叶酸钙和叶酸联合治疗（124 [64.2%]），86 名（44.6%）接受了放化疗。NT 前后成像的中位间隔时间为 6 个月（四分位距 [IQR]，4-7 个月）。所有身体隔室均显著变化。脂肪化合物减少（中位数总脂肪组织面积从 284.0 cm2；IQR，171.0-414.0 降至 250.0 cm2；IQR，139.0-363.0；P < .001；中位数内脏脂肪组织面积从 115.2 cm2；IQR，59.9-191.0 降至 97.7 cm2；IQR，48.0-149.0 cm2；P < .001），而瘦体重略有改善（中位数骨骼肌从 122.1 cm2；IQR，99.3-142.0 增加到 123 cm2；IQR 104.8-152.5 cm2；P = .001）。136 名（70.5%）患者可进行切除术。接受切除术的患者在 NT 治疗期间经历了 5.9%的骨骼肌面积增加，而未接受切除术的患者骨骼肌面积减少了 1.7%（P < .001）。
PC 患者在新辅助化疗期间经历了显著的脂肪组织损失，但没有肌肉消耗。NT 期间肌肉组织的增加与可切除性相关。
