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Original Investigation
September 2018

Association Between Changes in Body Composition and Neoadjuvant Treatment for Pancreatic Cancer

Author Affiliations
  • 1Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
  • 2Department of Surgery, School of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
  • 3Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
  • 4Department of Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy
  • 5Department of Radiology, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy
  • 6Department of Radiology, School of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
  • 7Department of Oncology, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy
  • 8Department of Surgery, Vita-Salute San Raffaele University, Milan, Italy
  • 9Department of Radiology, Vita-Salute San Raffaele University, Milan, Italy
JAMA Surg. 2018;153(9):809-815. doi:10.1001/jamasurg.2018.0979
Key Points

Question  Does neoadjuvant treatment affect muscle mass and adipose tissue in patients with borderline resectable and locally advanced pancreatic cancer, and are there any differences in those changes between patients who eventually undergo resection and those who do not?

Findings  During a 3-year cohort study, 193 patients were analyzed at 4 institutions. Adipose tissue significantly decreased during neoadjuvant treatment, while muscle mass slightly increased. Patients who underwent resection experienced a higher increase in muscular tissue during neoadjuvant treatment compared with those who did not undergo resection.

Meaning  Lean tissue gain during neoadjuvant treatment for borderline resectable and locally advanced pancreatic cancer is associated with a higher likelihood of resection.

Abstract

Importance  Sarcopenia and sarcopenic obesity have been associated with poor outcomes in unresectable pancreatic cancer (PC). Neoadjuvant treatment (NT) is used increasingly to improve resectability; however, its effects on fat and muscle body composition have not been characterized.

Objectives  To evaluate whether NT affects muscle mass and adipose tissue in patients with borderline resectable PC (BRPC) and locally advanced PC (LAPC) and determine whether there were potential differences between patients who ultimately underwent resection and those who did not.

Design, Setting, and Participants  In this retrospective cohort study conducted at 4 academic medical centers, 193 patients with BRPC and LAPC undergoing surgical exploration after NT who had available computed tomographic scans (both at diagnosis and preoperatively) and confirmed pancreatic ductal adenocarcinoma were evaluated. The study was conducted from January 2013 to December 2015. Data analysis was performed from September 2016 to May 2017. Measurement of body compartments was evaluated with volume assessment software before and after NT. A radiologist blinded to the patient outcome assessed the areas of skeletal muscle, total adipose tissue, and visceral adipose tissue through a standardized protocol.

Exposures  Receipt of NT.

Main Outcomes and Measures  Achievement of pancreatic resection at surgical exploration after the receipt of NT.

Results  Of the 193 patients with complete radiologic imaging available after NT, 96 (49.7%) were women; mean (SD) age at diagnosis was 64 (11) years. Most patients received combined therapy with fluorouracil, irinotecan, oxaliplatin, leucovorin, and folic acid (124 [64.2%]) and 86 (44.6%) received chemoradiotherapy as well. The median interval between pre-NT and post-NT imaging was 6 months (interquartile range [IQR], 4-7 months). All body compartments significantly changed. The adipose compound decreased (median total adipose tissue area from 284.0 cm2; IQR, 171.0-414.0 to 250.0 cm2; IQR, 139.0-363.0; P < .001; median visceral adipose tissue area from 115.2 cm2; IQR, 59.9-191.0 to 97.7 cm2; IQR, 48.0-149.0 cm2; P < .001), whereas the lean mass slightly improved (median skeletal muscle from 122.1 cm2; IQR, 99.3-142.0 to 123 cm2; IQR 104.8-152.5 cm2; P = .001). Surgical resection was achievable in 136 (70.5%) patients. Patients who underwent resection had experienced a 5.9% skeletal muscle area increase during NT treatment, whereas those who did not undergo resection had a 1.7% decrease (P < .001).

Conclusions and Relevance  Patients with PC experience a significant loss of adipose tissue during neoadjuvant chemotherapy, but no muscle wasting. An increase in muscle tissue during NT is associated with resectability.

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