Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan;
Department of Surgery, Yokohama City University, Yokohama, Japan.
Anticancer Res. 2024 Oct;44(10):4569-4577. doi: 10.21873/anticanres.17286.
BACKGROUND/AIM: Although perioperative chemotherapy has improved patient survival, sarcopenia may occur during chemotherapy owing to decreased food intake and physical strength. However, reports on the occurrence of sarcopenia and changes in body composition in patients with pancreatic cancer during neoadjuvant chemotherapy are scarce. This study aimed to determine the effect of changes in skeletal muscle mass during neoadjuvant chemotherapy on the S-1 adjuvant chemotherapy clinical course in patients who underwent perioperative chemotherapy and surgical resection.
We retrospectively enrolled 159 patients with pancreatic cancer who underwent neoadjuvant chemotherapy and surgical resection, followed by S-1 adjuvant chemotherapy. We evaluated changes in skeletal muscle mass during neoadjuvant chemotherapy using abdominal computed tomography and the SliceOmatic software. The association between the rate of change in skeletal muscle mass index (Δ%SMI) during neoadjuvant chemotherapy and the continuation of S-1 adjuvant chemotherapy was investigated.
Eighty-eight (55.3%) patients lost skeletal muscle mass (Δ%SMI <0) during neoadjuvant chemotherapy with a significantly low S-1 adjuvant completion rate (p=0.02). Δ%SMI <0 was an independent risk factor for the continuation of S-1 adjuvant chemotherapy (hazard ratio=1.924, 95% confidence interval=1.002-3.695, p=0.049). Moreover, the lower the Δ%SMI, the lower the S-1 continuation rate (p=0.022).
Loss of skeletal muscle mass during neoadjuvant chemotherapy for pancreatic cancer affected the continuation of S-1 adjuvant chemotherapy after pancreatic resection. Therefore, ameliorating loss of skeletal muscle mass during neoadjuvant chemotherapy should be carefully considered to improve the continuation rate of adjuvant chemotherapy and the survival of patients with pancreatic cancer.
背景/目的：尽管围手术期化疗提高了患者的生存率，但由于食物摄入和体力下降，化疗期间可能会发生肌肉减少症。然而，关于新辅助化疗期间胰腺癌患者发生肌肉减少症和身体成分变化的报道很少。本研究旨在确定新辅助化疗期间骨骼肌质量变化对接受围手术期化疗和手术切除的患者接受 S-1 辅助化疗临床过程的影响。
我们回顾性纳入了 159 例接受新辅助化疗和手术切除、随后接受 S-1 辅助化疗的胰腺癌患者。我们使用腹部计算机断层扫描和 SliceOmatic 软件评估新辅助化疗期间骨骼肌质量的变化。研究了新辅助化疗期间骨骼肌质量指数（%SMI）变化率（Δ%SMI）与 S-1 辅助化疗持续时间的关系。
88 例（55.3%）患者在新辅助化疗期间失去了骨骼肌质量（Δ%SMI <0），S-1 辅助化疗完成率显著较低（p=0.02）。Δ%SMI <0 是 S-1 辅助化疗持续的独立危险因素（危险比=1.924，95%置信区间=1.002-3.695，p=0.049）。此外，Δ%SMI 越低，S-1 持续率越低（p=0.022）。
胰腺癌新辅助化疗期间骨骼肌质量的损失影响了胰腺切除后 S-1 辅助化疗的持续时间。因此，应谨慎考虑减轻新辅助化疗期间骨骼肌质量的损失，以提高辅助化疗的持续率和胰腺癌患者的生存率。
