Ferrostatin-1 br Surveillance E and End

2021-03-10

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Pancreatology
Characterising the impact of body composition change during neoadjuvant chemotherapy for pancreatic cancer
Oonagh M. Griffin a, b, *, Sinead N. Duggan a, Ronan Ryan c, Raymond McDermott d, Justin Geoghegan b, Kevin C. Conlon a, b
a Professorial Surgical Unit, Trinity College Dublin, Trinity Centre for Health Science, Tallaght, Dublin 24, Ireland
b National Surgical Centre for Pancreatic Cancer, St Vincent's University Hospital, Dublin 24, Ireland
c Department of Radiology, St Vincent's University Hospital, Dublin 24, Ireland
d Department of Medical Oncology, St Vincent's University Hospital, Dublin 24, Ireland
Article history:
Received in revised form
Available online xxx
Keywords:
Sarcopenia
Pancreatic cancer
Cancer cachexia
Background: Pancreatic Cancer remains a lethal disease for the majority of patients. New chemotherapy agents such as Folfirinox offer therapeutic potential for patients who present with Borderline Resectable disease (BRPC). However, results to date are inconsistent, with factors such as malnutrition limiting successful drug delivery. We sought to determine the prevalence of sarcopenia in BRPC patients at diagnosis, and to quantify body composition change during chemotherapy.
Methods: The diagnostic/restaging CT scans of BRPC patients were analysed. Body composition was measured at L3 using Tomovision Slice-O-Matic™. Total muscle and adipose tissue mass were estimated using validated regression equations. Sarcopenia was defined as per gender- and body mass index (BMI)-specific lumbar skeletal muscle index (LSMI) and muscle attenuation reference values.
Results: Seventy-eight patients received neo-adjuvant chemotherapy, and 67 patients underwent restaging CT, at which point a third were deemed resectable. Half were sarcopenic at diagnosis, and sarcopenia was equally prevalent across all BMI categories.. Skeletal muscle and adipose tissue (intra-muscular, visceral and sub-cutaneous) area decreased during chemotherapy (p < 0.0001). Low muscle attenuation was observed in half of patients at diagnosis, and was associated with increased mortality risk. Loss of lean tissue parameters during chemotherapy was associated with an increased mortality risk; specifically fat-free mass, HR 1.1 (95% CI 1.03e1.17, p ¼ 0.003) and skeletal muscle mass, HR 1.21 (95%CI 1.08e1.35, p ¼ 0.001).
Conclusions: Sarcopenia was prevalent in half of patients at the time of diagnosis with BRPC. Low muscle attenuation at diagnosis, coupled with lean tissue loss during chemotherapy, independently increased mortality risk.
© 2019 IAP and EPC. Published by Elsevier B.V. All rights reserved.
Introduction
Pancreatic cancer is currently the fourth leading cause of cancer related mortality in Europe [1], with median 5-year survival rates largely remaining static over the last 40 years [2]. Patients frequently present with advanced disease at the time of diagnosis, limiting their potential for curative resection. Recent developments include international consensus regarding disease staging and
* Corresponding author. Professorial Surgical Unit, Trinity College Dublin, Room 1.29 Trinity Centre for Health Sciences, Tallaght, Dublin 24, Ireland.