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PLoS One. 2015;10(10):e0139749.

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

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제1저자 최연악 · 교신저자 오도연

PMID 26437072 PMC4593598 DOI 10.1371/journal.pone.0139749 IF 2.8 혈액종양내과
소속 (2)
  1. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
  2. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, 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.

Figures

Fig 1
Fig 1 Computed tomography images of the region of the third lumbar vertebra, with skeletal muscle highlighted in blue (-29 to 150 Hounsfield units). The blue line on the three-dimensionally reconstructed image on the left indicates the level of the third lumbar vertebra, which is shown in the axial view on the right.
Fig 2
Fig 2 ROC curve ofsarcopenia for both genders.
Fig 3
Fig 3 Survival according to skeletal muscle index. Initial SMI was related to worse prognosis (A) for the entire patients (HR 1.721; P < 0.001); (B) for the male patients (HR 1.736; P < 0.001); (C) not for female patients (P = 0.299).
Fig 4
Fig 4 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).

그림 출처: PubMed Central 공개 논문 (PMC4593598)

Conflict of interest statement

Competing Interests:The authors have declared that no competing interests exist.

그 밖의 정보
출판 형태
Journal Article
저널
PloS one · eISSN 1932-6203
전자 출판
2015-10-05
MeSH
Adult · Aged · Aged, 80 and over · Body Composition · Body Mass Index · Female · Humans · Male · Middle Aged · Muscle, Skeletal / diagnostic imaging / pathology · Muscular Atrophy / diagnostic imaging / mortality / pathology · Palliative Care* · Pancreatic Neoplasms / diagnostic imaging / drug therapy / mortality / pathology · Prognosis · Radiography · Retrospective Studies · Sarcopenia / diagnostic imaging / mortality / pathology · Young Adult
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