HPB
non-CME
Elliott J. Yee, MD (he/him/his)
Resident Physician
University of Colorado
Denver, Colorado, United States
Disclosure information not submitted.
Elliott J. Yee, MD (he/him/his)
Resident Physician
University of Colorado
Denver, Colorado, United States
Disclosure information not submitted.
Christopher Quinn, MS
Research Instructor
Surgical Outcomes and Applied Research (SOAR) and Department of Surgery University of Colorado Anschutz Medical Campus, United States
Disclosure information not submitted.
.jpg "Robert J. Torphy, MD PhD photo")
Robert J. Torphy, MD PhD
General Surgery Resident
University of Colorado
Denver, Colorado, United States
Disclosure information not submitted.
Emily Myers, MD
Resident Physician
University of Colorado, United States
Disclosure information not submitted.
Toshimasa Clark, MD
Assistant Professor
University of Colorado, United States
Disclosure information not submitted.
Carlton Barnett, MD
Professor
University of Colorado, United States
Disclosure information not submitted.
Marco Del Chiaro, MD, PhD, FACS
Professor
University of Colorado School of Medicine, Department of Surgery, Division of Surgical Oncology, United States
Disclosure information not submitted.
Richard Schulick, MD, MBA, FACS
Chair
University of Colorado School of Medicine, Department of Surgery, Division of Surgical Oncology, United States
Disclosure information not submitted.
Martin McCarter, MD
Professor of Surgery
University of Colorado School of Medicine
Disclosure information not submitted.
Body composition analysis, known as anthropometrics, has been associated with outcomes in pancreatic adenocarcinoma (PDAC). Few studies have examined the significance of dynamic changes in anthropometrics overtime on outcomes in PDAC. Here, we identify relationships between dynamic anthropometrics and perioperative and oncopathologic outcomes in the age of contemporary neoadjuvant therapy (NAT) for PDAC.
Methods:
Patients from a single center undergoing NAT for borderline or locally advanced PDAC who were offered curative-intent pancreatectomy were reviewed. Anthropometrics (skeletal muscle, visceral and subcutaneous adipose tissue areas) were captured from CT scans before and after NAT using AI-driven segmentation software which were validated by a subspecialty-trained radiologist. Skeletal muscle (SMI) and adipose tissue (ATI) indexes were normalized to height at the level of the L3 lumbar spine. Sarcopenia was defined using published, gender-adjusted norms for SMI. Primary outcome was overall survival; secondary outcomes included additional oncologic, histopathologic, and post-operative measures.
Results:
A total of 148 patients met inclusion criteria. Fifty-one percent were female; 53% received neoadjuvant chemotherapy alone; 50% were classified as borderline resectable; 75% underwent pancreaticoduodenectomy. Skeletal muscle and adipose tissue both significantly decreased during NAT. Twenty-nine patients were sarcopenic at diagnosis (21%); 15 patients (11%) became sarcopenic after NAT. Decline in SMI was associated with positive superior mesenteric artery margin (p=0.01); decrease in ATI was associated with blood product transfusion postoperatively (p=0.01). Multivariate Cox models showed development of sarcopenia was a significant predictor of worse overall survival (HR 3.8; CI 1.5-9.9; p=0.01) and shorter recurrence-free survival (HR 3.0; CI 1.1-8.4; p=0.04).
Conclusions:
Repeated measurement of anthropometrics during NAT conveys valuable information regarding outcomes and potentially tumor biology of PDAC. This study suggests further investigation into the potential mechanisms of skeletal muscle loss, tumor-host interaction, and possible interventions to optimize body composition during NAT.