University of Cincinnati, Cincinnati, Ohio, United States.
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington State, United States.
J Gastrointest Surg. 2024 Mar;28(3):232-235. doi: 10.1016/j.gassur.2023.12.022. Epub 2024 Jan 19.
Sarcopenic obesity and muscle attenuation have been associated with survival in patients with borderline resectable and advanced pancreatic ductal adenocarcinoma (PDA); however, these relationships are unknown for patients with resectable PDA. This study examined the associations between skeletal muscle and adipose tissue as measured on baseline computed tomography (CT) and the overall survival (OS) of participants with resectable PDA in a secondary analysis of the Southwest Oncology Group S1505 clinical trial (identifier: NCT02562716).
The S1505 phase II clinical trial enrolled patients with resectable PDA who were randomized to receive modified FOLFIRINOX or gemcitabine and nab-paclitaxel as perioperative chemotherapy, followed by surgical resection. Baseline axial CT images at the L3 level were analyzed with externally validated software, and measurements were recorded for skeletal muscle area and skeletal muscle density, visceral adipose tissue area (VATA) and density, and subcutaneous adipose tissue area and density. The relationships between CT metrics and OS were analyzed using Cox regression models, with adjustment for baseline participant characteristics.
Of 98 eligible participants with available baseline abdominal CT, 8 were excluded because of imaging quality (eg, orthopedic hardware), resulting in 90 evaluable cases: 51 men (57.0%; mean age, 63.2 years [SD, 8.5]; mean body mass index [BMI], 29.3 kg/m [SD, 6.4]), 80 White (89.0%), 6 Black (7.0%), and 4 unknown race (4.0%). Sarcopenia was present in 32 participants (35.9%), and sarcopenic obesity was present in 10 participants (11.2%). Univariable analyses for the 6 variables of interest indicated that the standardized mean difference (hazard ratio [HR], 0.75; 95% CI, 0.57-0.98; P = .04) was statistically significantly associated with OS. In models adjusted for sex, race, age, BMI, performance score, contrast use, sarcopenia, and sarcopenic obesity, VATA was statistically significantly associated with OS (HR, 1.58; 95% CI, 1.00-2.51; P = .05). No difference was observed in OS between participants according to sarcopenic obesity or sarcopenia categories. The median OS estimates were 25.1 months for participants without sarcopenic obesity, 18.6 months for participants with sarcopenic obesity, 23.6 months for participants without sarcopenia, and 27.9 months for participants with sarcopenia.
This was the first study to systematically evaluate body composition parameters in a prospective multicenter trial of patients with resectable PDA who received perioperative chemotherapy. Visceral adipose tissue was associated with survival; however, there was no association between OS and sarcopenia or sarcopenic obesity. Further studies should evaluate these findings in more detail.
在边界可切除和晚期胰腺导管腺癌（PDA）患者中，肌肉减少症和肌肉衰减与生存有关；然而，在可切除 PDA 患者中，这些关系尚不清楚。本研究通过对西南肿瘤协作组 S1505 临床试验（标识符：NCT02562716）的二次分析，检查了基线计算机断层扫描（CT）上骨骼肌和脂肪组织与可切除 PDA 患者总生存（OS）之间的相关性。
S1505 二期临床试验招募了可切除 PDA 患者，他们被随机分配接受改良 FOLFIRINOX 或吉西他滨和 nab-紫杉醇作为围手术期化疗，然后进行手术切除。使用经过外部验证的软件分析 L3 水平的轴向 CT 图像，并记录骨骼肌面积和骨骼肌密度、内脏脂肪组织面积（VATA）和密度、皮下脂肪组织面积和密度的测量值。使用 Cox 回归模型分析 CT 指标与 OS 的关系，并根据基线参与者特征进行调整。
在 98 名有基线腹部 CT 的合格参与者中，有 8 名因影像学质量（例如，骨科硬件）而被排除在外，最终有 90 例可评估病例：51 名男性（57.0%；平均年龄 63.2 岁[标准差，8.5]；平均体重指数[BMI]，29.3 kg/m [标准差，6.4]），80 名白人（89.0%），8 名黑人（7.0%），4 名未知种族（4.0%）。32 名参与者存在肌肉减少症（35.9%），10 名参与者存在肌肉减少性肥胖症（11.2%）。6 个感兴趣变量的单变量分析表明，标准化均差（HR，0.75；95%CI，0.57-0.98；P=.04）与 OS 具有统计学显著相关性。在调整了性别、种族、年龄、BMI、表现评分、对比剂使用、肌肉减少症和肌肉减少性肥胖症的模型中，VATA 与 OS 具有统计学显著相关性（HR，1.58；95%CI，1.00-2.51；P=.05）。根据肌肉减少性肥胖症或肌肉减少症类别，OS 在参与者之间没有差异。无肌肉减少性肥胖症参与者的中位 OS 估计值为 25.1 个月，有肌肉减少性肥胖症的参与者为 18.6 个月，无肌肉减少症的参与者为 23.6 个月，有肌肉减少症的参与者为 27.9 个月。
这是第一项在接受围手术期化疗的可切除 PDA 患者的前瞻性多中心试验中系统评估身体成分参数的研究。内脏脂肪组织与生存有关；然而，OS 与肌肉减少症或肌肉减少性肥胖症之间没有关联。应进一步研究以更详细地评估这些发现。
