title: Prognostic Significance of Muscle Attenuation in Pancreatic Cancer Patients Treated with Neoadjuvant Chemoradiotherapy.
abstract: BACKGROUND
  Emerging evidences have gradually revealed the skeletal muscle attenuation (MA) was not only reflected the accumulation of lipids in skeletal muscle but also associated with physiological and pathological states. The aim of this study was to evaluate the impact of MA on the prognosis of pancreatic cancer patients treated with neoadjuvant chemoradiotherapy (NACRT).
  
  
  METHODS
  Eighty-three patients with pancreatic cancer who received NACRT were enrolled. Patients were divided according to their Hounsfield units of the skeletal muscle at the third lumbar vertebra in CT. The lower quartile was defined as MA group and the remainder as control group.
  
  
  RESULTS
  There was no significant difference in overall survival between pre-NACRT MA and control groups. In contrast, patients with post-NACRT MA had a significantly poorer prognosis than patients without. The patients in the post-NACRT MA group were significantly older than patients in the control group. There were no significant differences in most clinicopathological and perioperative factors between both groups. However, patients with post-NACRT MA had a longer hospital stay than patients without. Furthermore, the incompletion rate of the proposed adjuvant chemotherapy was significantly higher in the MA group than control. Importantly, multivariate analysis indicated that post-NACRT MA was an independent prognostic factor.
  
  
  CONCLUSIONS
  Muscle attenuation may have a significant impact in pancreatic cancer patients treated with multimodal therapy. Therefore, our data may provide new insights into perioperative patient care to improve the prognosis of resectable pancreatic cancer.
authors: Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors: Takahiro
authors: T
authors: Akahori
authors: Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. m-sho@naramed-u.ac.jp.
authors: Masayuki
authors: M
authors: Sho
authors: Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors: Shoichi
authors: S
authors: Kinoshita
authors: Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors: Minako
authors: M
authors: Nagai
authors: Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors: Satoshi
authors: S
authors: Nishiwada
authors: Department of Radiology, Nara Medical University, Nara, 634-8522, Japan.
authors: Toshihiro
authors: T
authors: Tanaka
authors: Department of Radiation Oncology, Nara Medical University, Nara, 634-8522, Japan.
authors: Tetsuro
authors: T
authors: Tamamoto
authors: Department of Diagnostic Pathology, Nara Medical University, Nara, 634-8522, Japan.
authors: Chiho
authors: C
authors: Ohbayashi
authors: Department of Radiation Oncology, Nara Medical University, Nara, 634-8522, Japan.
authors: Masatoshi
authors: M
authors: Hasegawa
authors: Department of Radiology, Nara Medical University, Nara, 634-8522, Japan.
authors: Kimihiko
authors: K
authors: Kichikawa
authors: Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors: Yoshiyuki
authors: Y
authors: Nakajima
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000368:Aged; D064131:Back Muscles / Q000000981:diagnostic imaging*; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D007902:Length of Stay; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000628:therapy*; D011379:Prognosis; D015996:Survival Rate; D014057:Tomography, X-Ray Computed