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Skeletal Muscle Depletion Predicts the Prognosis of Patients with Advanced Pancreatic Cancer Undergoing Palliative Chemotherapy, Independent of Body Mass Index.

Choi Y, Oh DY, Kim TY, Lee KH, Han SW, Im SA, Kim TY, Bang YJ - PLoS ONE (2015)

Bottom Line: Among 484 patients, 103 (21.3%) patients were sarcopenic at diagnosis.Decrease in body mass index (BMI) was observed in 149 patients (37.3%), with no gender difference.While the OS of male patients was affected with sarcopenia (P< 0.001) and decreased SMI (P = 0.001), the OS of female patients was influenced with overweight at diagnosis (P = 0.006), decreased BMI (P = 0.032) and decreased SMI (P = 0.014).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.

ABSTRACT

Introduction: Body composition has emerged as a prognostic factor in cancer patients. We investigated whether sarcopenia at diagnosis and loss of skeletal muscle during palliative chemotherapy were associated with survival in patients with pancreatic cancer.

Methods: We retrospectively reviewed the clinical outcomes of pancreatic cancer patients receiving palliative chemotherapy between 2003 and 2010. The cross-sectional area of skeletal muscle at L3 by computed tomography was analyzed with Rapidia 3D software. We defined sarcopenia as a skeletal muscle index (SMI)< 42.2 cm2/m2 (male) and < 33.9 cm2/m2 (female) using ROC curve.

Results: Among 484 patients, 103 (21.3%) patients were sarcopenic at diagnosis. Decrease in SMI during chemotherapy was observed in 156 (60.9%) male and 65 (40.6%) female patients. Decrease in body mass index (BMI) was observed in 149 patients (37.3%), with no gender difference. By multivariate analysis, sarcopenia (P< 0.001), decreasedBMI and SMI during chemotherapy (P = 0.002, P = 0.004, respectively) were poor prognostic factors for overall survival (OS). While the OS of male patients was affected with sarcopenia (P< 0.001) and decreased SMI (P = 0.001), the OS of female patients was influenced with overweight at diagnosis (P = 0.006), decreased BMI (P = 0.032) and decreased SMI (P = 0.014). Particularly, while the change of BMI during chemotherapy did not have impact on OS within the patients with maintained SMI (P = 0.750), decrease in SMI was associated with poor OS within the patients with maintained BMI (HR 1.502; P = 0.002).

Conclusions: Sarcopenia at diagnosis and depletion of skeletal muscle, independent of BMI change, during chemotherapy were poor prognostic factors in advanced pancreatic cancer.

No MeSH data available.


Related in: MedlinePlus

Survival according to change in body mass indexand skeletal muscle index.BMI decreased by more than 1 kg/m2 and SMI decreased by more than 2 cm2/m2 were strongly related to worseoutcome. Decrease of BMI (A) for the entire patients (HR 1.452; P = 0.002); (B) for the male patients (HR 1.218; P = 0.142); (C) for the female patients (HR 1.464; P = 0.032). Decrease of SMI (D) for the entire patients (HR 1.390;P = 0.004); (E) for the male patients (HR 1.560; P = 0.001); (F) for the female patients (HR 1.521; P = 0.014).
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pone.0139749.g004: Survival according to change in body mass indexand skeletal muscle index.BMI decreased by more than 1 kg/m2 and SMI decreased by more than 2 cm2/m2 were strongly related to worseoutcome. Decrease of BMI (A) for the entire patients (HR 1.452; P = 0.002); (B) for the male patients (HR 1.218; P = 0.142); (C) for the female patients (HR 1.464; P = 0.032). Decrease of SMI (D) for the entire patients (HR 1.390;P = 0.004); (E) for the male patients (HR 1.560; P = 0.001); (F) for the female patients (HR 1.521; P = 0.014).

Mentions: Table 3 shows the effect of multiple clinical factors on OS. By multivariate analysis, sarcopenia (HR 1.721; 95% CI 1.298–2.284; P < 0.001; Fig 3A), decreased BMI (HR 1.452; 95% CI 1.148–1.836; P = 0.002; Fig 4A), and decreased SMI (HR 1.390; 95% CI 1.109–1.742; P = 0.004; Fig 4D) were associated with poor survival. For male patients, sarcopenia (median OS of 6.1 vs 9.4 months; HR 1.736, 95% CI 1.310–2.300; P < 0.001; Fig 3B) and decreasedSMI (median OS of 8.2 vs 10.7 months; HR 1.560, 95% CI 1.199–2.030; P = 0.001; Fig 4E) was strongly related to worse prognosis. However,decreased BMI(median OS 8.9 vs 9.3 months; HR 1.218, 95% CI 0.936–1.585; P = 0.142; Fig 4B) showed a trend to worse prognosisand BMI at diagnosis did not influence on OS (P = 0.357). For female patients, both overweight at diagnosis (HR2.069, 95% CI 1.232–3.475; P = 0.006) and decreased BMI (median OS 8.2 vs 10.2 months; HR 1.464, 95% CI 1.034–2.071; P = 0.032; Fig 4C) were significantly associated with worse prognosis. However, while decreased SMI(medianOS 8.8 vs 9.9 months; HR 1.521, 95% CI 1.090–2.124; P = 0.014; Fig 4F) waspoor prognostic, sarcopenia at diagnosis had no relation with OS (P = 0.299; Fig 3C) (Table 4).


Skeletal Muscle Depletion Predicts the Prognosis of Patients with Advanced Pancreatic Cancer Undergoing Palliative Chemotherapy, Independent of Body Mass Index.

Choi Y, Oh DY, Kim TY, Lee KH, Han SW, Im SA, Kim TY, Bang YJ - PLoS ONE (2015)

Survival according to change in body mass indexand skeletal muscle index.BMI decreased by more than 1 kg/m2 and SMI decreased by more than 2 cm2/m2 were strongly related to worseoutcome. Decrease of BMI (A) for the entire patients (HR 1.452; P = 0.002); (B) for the male patients (HR 1.218; P = 0.142); (C) for the female patients (HR 1.464; P = 0.032). Decrease of SMI (D) for the entire patients (HR 1.390;P = 0.004); (E) for the male patients (HR 1.560; P = 0.001); (F) for the female patients (HR 1.521; P = 0.014).
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4593598&req=5

pone.0139749.g004: Survival according to change in body mass indexand skeletal muscle index.BMI decreased by more than 1 kg/m2 and SMI decreased by more than 2 cm2/m2 were strongly related to worseoutcome. Decrease of BMI (A) for the entire patients (HR 1.452; P = 0.002); (B) for the male patients (HR 1.218; P = 0.142); (C) for the female patients (HR 1.464; P = 0.032). Decrease of SMI (D) for the entire patients (HR 1.390;P = 0.004); (E) for the male patients (HR 1.560; P = 0.001); (F) for the female patients (HR 1.521; P = 0.014).
Mentions: Table 3 shows the effect of multiple clinical factors on OS. By multivariate analysis, sarcopenia (HR 1.721; 95% CI 1.298–2.284; P < 0.001; Fig 3A), decreased BMI (HR 1.452; 95% CI 1.148–1.836; P = 0.002; Fig 4A), and decreased SMI (HR 1.390; 95% CI 1.109–1.742; P = 0.004; Fig 4D) were associated with poor survival. For male patients, sarcopenia (median OS of 6.1 vs 9.4 months; HR 1.736, 95% CI 1.310–2.300; P < 0.001; Fig 3B) and decreasedSMI (median OS of 8.2 vs 10.7 months; HR 1.560, 95% CI 1.199–2.030; P = 0.001; Fig 4E) was strongly related to worse prognosis. However,decreased BMI(median OS 8.9 vs 9.3 months; HR 1.218, 95% CI 0.936–1.585; P = 0.142; Fig 4B) showed a trend to worse prognosisand BMI at diagnosis did not influence on OS (P = 0.357). For female patients, both overweight at diagnosis (HR2.069, 95% CI 1.232–3.475; P = 0.006) and decreased BMI (median OS 8.2 vs 10.2 months; HR 1.464, 95% CI 1.034–2.071; P = 0.032; Fig 4C) were significantly associated with worse prognosis. However, while decreased SMI(medianOS 8.8 vs 9.9 months; HR 1.521, 95% CI 1.090–2.124; P = 0.014; Fig 4F) waspoor prognostic, sarcopenia at diagnosis had no relation with OS (P = 0.299; Fig 3C) (Table 4).

Bottom Line: Among 484 patients, 103 (21.3%) patients were sarcopenic at diagnosis.Decrease in body mass index (BMI) was observed in 149 patients (37.3%), with no gender difference.While the OS of male patients was affected with sarcopenia (P< 0.001) and decreased SMI (P = 0.001), the OS of female patients was influenced with overweight at diagnosis (P = 0.006), decreased BMI (P = 0.032) and decreased SMI (P = 0.014).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.

ABSTRACT

Introduction: Body composition has emerged as a prognostic factor in cancer patients. We investigated whether sarcopenia at diagnosis and loss of skeletal muscle during palliative chemotherapy were associated with survival in patients with pancreatic cancer.

Methods: We retrospectively reviewed the clinical outcomes of pancreatic cancer patients receiving palliative chemotherapy between 2003 and 2010. The cross-sectional area of skeletal muscle at L3 by computed tomography was analyzed with Rapidia 3D software. We defined sarcopenia as a skeletal muscle index (SMI)< 42.2 cm2/m2 (male) and < 33.9 cm2/m2 (female) using ROC curve.

Results: Among 484 patients, 103 (21.3%) patients were sarcopenic at diagnosis. Decrease in SMI during chemotherapy was observed in 156 (60.9%) male and 65 (40.6%) female patients. Decrease in body mass index (BMI) was observed in 149 patients (37.3%), with no gender difference. By multivariate analysis, sarcopenia (P< 0.001), decreasedBMI and SMI during chemotherapy (P = 0.002, P = 0.004, respectively) were poor prognostic factors for overall survival (OS). While the OS of male patients was affected with sarcopenia (P< 0.001) and decreased SMI (P = 0.001), the OS of female patients was influenced with overweight at diagnosis (P = 0.006), decreased BMI (P = 0.032) and decreased SMI (P = 0.014). Particularly, while the change of BMI during chemotherapy did not have impact on OS within the patients with maintained SMI (P = 0.750), decrease in SMI was associated with poor OS within the patients with maintained BMI (HR 1.502; P = 0.002).

Conclusions: Sarcopenia at diagnosis and depletion of skeletal muscle, independent of BMI change, during chemotherapy were poor prognostic factors in advanced pancreatic cancer.

No MeSH data available.


Related in: MedlinePlus