Relationships among body mass index, longitudinal body composition alterations, and survival in patients with locally advanced pancreatic cancer receiving chemoradiation: a pilot study.
BACKGROUND
In pancreatic cancer, the presence of obesity or weight loss is associated with higher mortality.


OBJECTIVE
To explore the relationships among body mass index, longitudinal body composition alterations, and clinical outcomes in pancreatic cancer patients.


METHODS
Records of 41 patients with inoperable locally advanced pancreatic cancer who participated in a prospective chemoradiation study were reviewed. Body composition was analyzed from two sets of computed tomography images obtained before and after radiation treatment (median interval 104 days).


RESULTS
Median age was 59 years and 56% of patients were female. Twenty-four (59%) patients were either overweight (22%) or obese (37%). Sarcopenia was present in 26 (63%) patients. At follow-up, weight loss was experienced by 33 (81%) patients. The median losses (%) before and after treatment were weight 5% (P<0.001), skeletal muscle (SKM) 4% (P=0.003), visceral adipose tissue (VAT) 13% (P<0.001), and subcutaneous adipose tissue 11% (P=0.002). SKM loss positively correlated with age (P=0.03), baseline body mass index (P<0.001), and VAT (P=0.04) index. Obese patients experienced higher losses in weight (P=0.009), SKM (P=0.02), and VAT (P=0.02). Median survival was 12 months. In univariate analysis, age, baseline obesity, sarcopenic obesity, and losses (%) in weight, SKM, and VAT were associated with worse survival. In multivariate analysis, only age (hazard ratio=1.033, P=0.04) and higher VAT loss (hazard ratio=2.6 and P=0.03) remained significant.


CONCLUSIONS
Our preliminary findings suggest that obese patients experience higher losses in weight, SKM, and VAT, which may contribute to poorer survival in these patients.
University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. sdalal@mdanderson.org
Shalini
S
Dalal
David
D
Hui
Luc
L
Bidaut
Kristen
K
Lem
Egidio
E
Del Fabbro
Christopher
C
Crane
Cielito C
CC
Reyes-Gibby
Deepak
D
Bedi
Eduardo
E
Bruera
D000273:Adipose Tissue / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D001823:Body Composition / Q000502:physiology*; D015992:Body Mass Index; D002100:Cachexia / Q000209:etiology / Q000473:pathology; D059248:Chemoradiotherapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy*; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D015431:Weight Loss / Q000502:physiology