Introduction
Sarcopenia or visceral fat has been reported to be related to pancreatic cancer prognosis. However, clinical relevance of the comprehensive analysis of body compositions and their longitudinal changes is lacking. Therefore, this study analyzed the association between body composition changes after chemotherapy and survival in patients with metastatic pancreatic cancer.
Aims & Methods
We retrospectively included 456 patients (mean age±standard deviation, 61.2±10.0 years; 272 males and 184 females) with metastatic pancreatic cancer who received palliative chemotherapy from May 2011 to December 2019. Using deep learning-based, fully automated segmentation of initial computed tomography (CT), areas of muscle, subcutaneous fat, and visceral fat were extracted from a single axial image of the portal phase at the inferior endplate level of the L3 vertebra. Skeletal muscle index (SMI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and mean muscle attenuation (MA) at the inferior endplate level of L3 vertebra were calculated, and their effect on overall survival (OS) was analyzed. Longitudinal changes in body composition and prognostic values were also analyzed in a subgroup of patients with 2-month and 6-month follow-up CT (n=349).
Results
Higher MA at initial CT was significantly associated with better OS in both males and females (hazard ratio [HR]: 0.706; 95% confidence interval [CI], 0.538–0.925; P=0.012 for males, and 0.656; 95% CI, 0.475–0.906; P=0.010 for females), whereas higher SATI (HR, 0.568; 95% CI, 0.388–0.830; P=0.003) was significantly associated with better OS in female patients only. In longitudinal analysis, SMI, VATI, and SATI significantly decreased between initial and 2-month follow-up CT, whereas mean MA significantly decreased between 2-month and 6-month follow-up CT. In stratified cox regression analysis of longitudinal changes, SATI change was significantly associated with OS in male patients (HR, 0.513; 95% CI, 0.354–0.745; P<0.001), while other body composition parameters were not.
Table 4. Stratified Cox Regression Analysis of Overall survival with 2-month CT scan
| Male, univariable | Male, multivariable | Female, univariable | Female, multivariable |
| HR(95% CI) P value | HR(95% CI) P value | HR(95% CI) P value | HR(95% CI) P value |
| Age | 1.014 (1.001-1.028) 0.038 | 1.017 (1.003-1.032) 0.018 | 1.010 (0.992-1.027) 0.277 |
|
| CA19-9 ≥ 1000 | 1.369 (1.055-1.776) 0.018 | 1.370 (1.049-1.791) 0.021 | 2.031 (1.463-2.819) <0.001 | 1.864 (1.292-2.689) <0.001 |
| First CTx : FOLFIRINOX | 0.797 (0.591-1.075) 0.137 |
| 0.880 (0.630-1.229) 0.454 |
|
| Conversion surgery | 0.377 (0.205-0.694) 0.002 | 0.344 (0.176-0.672) 0.002 | 0.197 (0.062-0.624) 0.006 | 0.251 (0.076-0.821) 0.022 |
| δMA | 1.115 (0.497-2.498) 0.792 |
| 0.701 (0.307-1.599) 0.399 |
|
| δSMI | 1.467 (0.674-3.193) 0.335 |
| 0.079 (0.018-0.352) <0.001 | 0.171(0.025-1.165) 0.071 |
| δVATI | 0.987 (0.771-1.265) 0.920 |
| 0.701 (0.530-0.929) 0.013 |
|
| δSATI | 0.556 (0.385-0.803) 0.002 | 0.513 (0.354-0.745) <0.001 | 0.457 (0.232-0.901) 0.024 | 0.743 (0.363-1.520) 0.416 |
Conclusion
In patients with metastatic pancreatic cancer, body composition mostly changed during the first 2 months after starting chemotherapy, and the prognostic factors associated with OS differed between males and females. Therefore, deep learning-based body composition analysis can help predict metastatic pancreatic cancer prognosis.
References
1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021;71(3):209-249.
2. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin 2021;71(1):7-33.
3. Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 2008;9(7):629-635.
4. The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2019;4(12):934-947.
5. Michaud DS, Giovannucci E, Willett WC, Colditz GA, Stampfer MJ, Fuchs CS. Physical activity, obesity, height, and the risk of pancreatic cancer. Jama 2001;286(8):921-929.
6. Andersen DK, Korc M, Petersen GM, et al. Diabetes, Pancreatogenic Diabetes, and Pancreatic Cancer. Diabetes 2017;66(5):1103-1110.
7. Park JH, Han K, Hong JY, et al. Changes in Metabolic Syndrome Status are Associated With Altered Risk of Pancreatic Cancer: A Nationwide Cohort Study. Gastroenterology 2022;162(2):509-520.e507.
Disclosure
We have no conflict of interest to disclose