Sarcopenia in an Overweight or Obese Patient Is an Adverse Prognostic Factor in Pancreatic Cancer

TLDR

In pancreatic cancer patients receiving palliative therapy, weight loss often occurs in individuals who are overweight, complicating traditional risk stratification, and longitudinal CT analysis shows progressive declines in fat‑free and fat mass indices over 135 days. The study aimed to determine whether CT‑derived weight and body composition, particularly sarcopenia, predict prognosis in pancreatic cancer patients. The authors analyzed CT scans from 111 palliative‑therapy patients, with 44 having follow‑up scans, to track body composition changes over time. Multivariate analysis identified age ≥ 59 years and overweight/obese sarcopenia as independent predictors of poorer survival, confirming that sarcopenia in overweight/obese pancreatic cancer patients is an adverse prognostic factor.

Abstract

The average weight-losing pancreatic cancer patient undergoing palliative therapy is frequently overweight rather than underweight, and this can confound conventional measures used for risk stratification. The aim of this study was to evaluate if weight and body composition, specifically sarcopenia, assessed from diagnostic computed tomography (CT) scans, is of prognostic value in patients with pancreatic cancer. The nature and extent of tissue loss over subsequent months was also evaluated.A total of 111 patients entering a palliative therapy program, who had CT images and had undergone nutritional screening, were studied. In patients for whom follow-up scans were available (n = 44), longitudinal changes in body composition were studied at a mean of 230 +/- 62 and 95 +/- 60 days prior to demise.Sixty-two patients (55.9%) were sarcopenic, 44 (39.6%) were overweight/obese, and 18 (16.2%) were both. Age > or =59 years (hazard ratio, 1.71; 95% confidence interval, 1.10-2.66; P = 0.018), and overweight/obese sarcopenia (hazard ratio, 2.07; 95% confidence interval, 1.23-3.50; P = 0.006) were identified as independent predictors of survival on multivariate analysis. Longitudinal analysis revealed that total fat-free mass index decreased from 15.5 +/- 2.5 kg/m(2) to 14.5 +/- 2.0 kg/m2 (P = 0.002), and total fat mass index decreased from 7.5 +/- 2.0kg/m2 to 6.0 +/- 1.5kg/m2 (P < 0.0001) over 135 days.Sarcopenia in overweight/obese patients with advanced pancreatic cancer is an occult condition but can be identified using CT scans. This condition is an independent adverse prognostic indicator that should be considered for stratification of patients' entering clinical trials, systemic therapy, or support care programs.