From the Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama.
Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima.
Pancreas. 2022 Feb 1;51(2):148-152. doi: 10.1097/MPA.0000000000001985.
The aim of the study was to clarify the association of skeletal muscle mass and the prognosis of unresectable pancreatic ductal adenocarcinoma (PDAC) treated with gemcitabine plus nab-paclitaxel (GnP).
We included 124 unresectable PDAC patients who received GnP chemotherapy. Skeletal muscle mass of the third lumbar vertebrae (L3) level was measured by computed tomography immediately before GnP initiation, and the skeletal muscle index (L3-SMI) was calculated. Sarcopenia was defined as L3-SMI less than 42 cm2/m2 in male patients and less than 38 cm2/m2 in female patients.
Sarcopenia was found in 63 patients (50.8%). There was no significant difference in overall survival (OS) between sarcopenia and nonsarcopenia patients; however, in elderly patients (>70 years), the OS of sarcopenia patients was significantly poorer than that of nonsarcopenia patients (390 vs 631 days, respectively; hazard ratio, 2.64; 95% confidence interval, 1.33-5.23). Multivariate analyses in elderly patients revealed that sarcopenia and tumor stage were independent poor prognostic factors. Despite the short OS of elderly sarcopenia patients, there were no significant differences in progression-free survival or response rate.
Sarcopenia diagnosed by L3-SMI is a prognostic factor in elderly patients who receive GnP for unresectable PDAC. However, GnP exhibits a certain efficacy in sarcopenia and nonsarcopenia patients.
本研究旨在阐明吉西他滨联合白蛋白紫杉醇（GnP）治疗不可切除胰腺导管腺癌（PDAC）患者的骨骼肌量与预后的关系。
我们纳入了 124 例接受 GnP 化疗的不可切除 PDAC 患者。在开始 GnP 治疗前，通过计算机断层扫描测量第 3 腰椎（L3）水平的骨骼肌量，并计算骨骼肌指数（L3-SMI）。男性患者的 L3-SMI 小于 42 cm2/m2，女性患者的 L3-SMI 小于 38 cm2/m2 定义为肌肉减少症。
63 例（50.8%）患者存在肌肉减少症。肌肉减少症和非肌肉减少症患者的总生存期（OS）无显著差异；然而，在老年患者（>70 岁）中，肌肉减少症患者的 OS 明显差于非肌肉减少症患者（分别为 390 天和 631 天；风险比，2.64；95%置信区间，1.33-5.23）。老年患者的多因素分析显示，肌肉减少症和肿瘤分期是独立的不良预后因素。尽管老年肌肉减少症患者的 OS 较短，但无进展生存期或缓解率无显著差异。
通过 L3-SMI 诊断的肌肉减少症是接受 GnP 治疗不可切除 PDAC 的老年患者的预后因素。然而，GnP 在肌肉减少症和非肌肉减少症患者中均具有一定的疗效。
