Sato Hiroki, Goto Takuma, Hayashi Akihiro, Kawabata Hidemasa, Okada Tetsuhiro, Takauji Shuhei, Sasajima Junpei, Enomoto Katsuro, Fujiya Mikihiro, Oyama Kyohei, Ono Yusuke, Sugitani Ayumu, Mizukami Yusuke, Okumura Toshikatsu
Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa, Japan.
Department of Cardiovascular Surgery, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa, Japan.
Pancreatology. 2021 Aug;21(5):892-902. doi: 10.1016/j.pan.2021.03.002. Epub 2021 Mar 6.
BACKGROUND/OBJECTIVES: Decrease in skeletal muscle mass and function is associated with a poor prognosis following surgical resection of pancreatic ductal adenocarcinomas (PDAs). This study evaluated whether skeletal muscle mass decrease affects PDA outcomes.
Data of 112 patients with advanced and unresectable PDA who underwent chemotherapy in a single institution were retrospectively analyzed. Information on age, sex, hematological investigations, including systemic inflammation-based markers and nutritional assessment biomarkers, and imaging parameters of skeletal muscle mass and visceral adipose tissue were retrieved from the patients' medical records. The efficiency of the Cox, Weibull, and standardized exponential models were compared using hazard ratios and the Akaike Information Criterion (AIC).
Results from the Weibull, Cox, and standardized exponential model analyses indicated that low skeletal muscle mass, Eastern Cooperative Oncology Group performance status (PS), and the requirement of biliary drainage were associated with the highest risk of death, followed by carcinoembryonic antigen (CEA) levels and the presence of ascites. The AIC value from the four significant parameters was lowest for the Weibull-exponential distribution (222.3) than that of the Cox (653.7) and standardized exponential models (265.7). We developed a model for estimating the 1-year survival probability using the Weibull-exponential distribution.
Low-skeletal muscle index, PS, requirement of biliary drainage, CEA levels, and presence of ascites are independent factors for predicting poor patient survival after chemotherapy. Improved survival modeling using a parametric approach may accurately predict the outcome of patients with advanced-stage PDA.
背景/目的：胰腺导管腺癌（PDA）手术切除后，骨骼肌质量和功能的下降与预后不良相关。本研究评估了骨骼肌质量下降是否会影响PDA的预后。
回顾性分析了在单一机构接受化疗的112例晚期不可切除PDA患者的数据。从患者病历中获取年龄、性别、血液学检查信息（包括基于全身炎症的标志物和营养评估生物标志物）以及骨骼肌质量和内脏脂肪组织的影像参数。使用风险比和赤池信息准则（AIC）比较Cox、Weibull和标准化指数模型的效率。
Weibull、Cox和标准化指数模型分析结果表明，低骨骼肌质量、东部肿瘤协作组（ECOG）体能状态（PS）以及胆汁引流需求与最高死亡风险相关，其次是癌胚抗原（CEA）水平和腹水的存在。对于四个显著参数，Weibull指数分布的AIC值（222.3）低于Cox模型（653.7）和标准化指数模型（265.7）。我们使用Weibull指数分布开发了一个估计1年生存概率的模型。
低骨骼肌指数、PS、胆汁引流需求、CEA水平和腹水的存在是预测化疗后患者生存不良的独立因素。使用参数方法改进生存模型可能准确预测晚期PDA患者的预后。
