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01-12-2015 | Original Scientific Report

Prognostic Significance of Muscle Attenuation in Pancreatic Cancer Patients Treated with Neoadjuvant Chemoradiotherapy

Authors: Takahiro Akahori, Masayuki Sho, Shoichi Kinoshita, Minako Nagai, Satoshi Nishiwada, Toshihiro Tanaka, Tetsuro Tamamoto, Chiho Ohbayashi, Masatoshi Hasegawa, Kimihiko Kichikawa, Yoshiyuki Nakajima

Published in: World Journal of Surgery | Issue 12/2015

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.

Li D, Xie K, Wolff R et al (2004) Pancreatic cancer. Lancet 363:1049–1057CrossRefPubMed

Traverso LW (2006) Pancreatic cancer: surgery alone is not sufficient. Surg Endosc 20(Suppl 2):S446–S449CrossRefPubMed

Schnelldorfer T, Ware AL, Sarr MG et al (2008) Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg 247:456–462CrossRefPubMed

Ferrone CR, Brennan MF, Gonen M et al (2008) Pancreatic adenocarcinoma: the actual 5-year survivors. J Gastrointest Surg 12:701–706CrossRefPubMed

Oettle H, Post S, Neuhaus P et al (2007) Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 297:267–277CrossRefPubMed

Ueno H, Kosuge T, Matsuyama Y et al (2009) A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer. Br J Cancer 101:908–915PubMedCentralCrossRefPubMed

Satoi S, Yanagimoto H, Toyokawa H et al (2009) Surgical results after preoperative chemoradiation therapy for patients with pancreatic cancer. Pancreas 38:282–288CrossRefPubMed

Sho M, Akahori T, Tanaka T et al (2013) Pathological and clinical impact of neoadjuvant chemoradiotherapy using full-dose gemcitabine and concurrent radiation for resectable pancreatic cancer. J Hepatobiliary Pancreat Sci 20:197–205CrossRefPubMed

Evans DB, Varadhachary GR, Crane CH et al (2008) Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol 26:3496–3502CrossRefPubMed

10.

Heinrich S, Schafer M, Weber A et al (2008) Neoadjuvant chemotherapy generates a significant tumor response in resectable pancreatic cancer without increasing morbidity: results of a prospective phase II trial. Ann Surg 248:1014–1022CrossRefPubMed

11.

Gillen S, Schuster T, Meyer Zum Buschenfelde C et al (2010) Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med 7:e1000267PubMedCentralCrossRefPubMed

12.

Ohigashi H, Ishikawa O, Eguchi H et al (2009) Feasibility and efficacy of combination therapy with preoperative full-dose gemcitabine, concurrent three-dimensional conformal radiation, surgery, and postoperative liver perfusion chemotherapy for T3-pancreatic cancer. Ann Surg 250:88–95CrossRefPubMed

13.

Clark JM, Brancati FL, Diehl AM (2003) The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol 98:960–967CrossRefPubMed

14.

Krssak M, Falk Petersen K, Dresner A et al (1999) Intramyocellular lipid concentrations are correlated with insulin sensitivity in humans: a 1H NMR spectroscopy study. Diabetologia 42:113–116CrossRefPubMed

15.

Montani JP, Carroll JF, Dwyer TM et al (2004) Ectopic fat storage in heart, blood vessels and kidneys in the pathogenesis of cardiovascular diseases. Int J Obes Relat Metab Disord 28(Suppl 4):S58–S65CrossRefPubMed

16.

Goodpaster BH, Kelley DE, Thaete FL et al (2000) Skeletal muscle attenuation determined by computed tomography is associated with skeletal muscle lipid content. J Appl Physiol 89:104–110PubMed

17.

Taaffe DR, Henwood TR, Nalls MA et al (2009) Alterations in muscle attenuation following detraining and retraining in resistance-trained older adults. Gerontology 55:217–223PubMedCentralCrossRefPubMed

18.

Martin L, Birdsell L, Macdonald N et al (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 31:1539–1547CrossRefPubMed

19.

Sabel MS, Lee J, Cai S et al (2011) Sarcopenia as a prognostic factor among patients with stage III melanoma. Ann Surg Oncol 18:3579–3585CrossRefPubMed

20.

Antoun S, Lanoy E, Iacovelli R et al (2013) Skeletal muscle density predicts prognosis in patients with metastatic renal cell carcinoma treated with targeted therapies. Cancer 119:3377–3384CrossRefPubMed

21.

Aubrey J, Esfandiari N, Baracos VE et al (2014) Measurement of skeletal muscle radiation attenuation and basis of its biological variation. Acta Physiol 210:489–497CrossRef

22.

Anderson DE, D’Agostino JM, Bruno AG et al (2013) Variations of CT-based trunk muscle attenuation by age, sex, and specific muscle. J Gerontol A Biol Sci Med Sci 68:317–323PubMedCentralCrossRefPubMed

23.

Chang D, Joseph DJ, Ebert MA et al (2014) Effect of androgen deprivation therapy on muscle attenuation in men with prostate cancer. J Med Imaging Radiat Oncol 58:223–228CrossRefPubMed

24.

Goodpaster BH, Thaete FL, Kelley DE (2000) Composition of skeletal muscle evaluated with computed tomography. Ann N Y Acad Sci 904:18–24CrossRefPubMed

25.

Kelley DE, Slasky BS, Janosky J (1991) Skeletal muscle density: effects of obesity and non-insulin-dependent diabetes mellitus. Am J Clin Nutr 54:509–515PubMed

26.

Sho M, Akahori T, Tanaka T et al (2015) Optimal indication of neoadjuvant chemoradiotherapy for pancreatic cancer. Langenbecks Arch Surg 400:477–485CrossRefPubMed

27.

Sho M, Akahori T, Tanaka T et al (2015) Importance of resectability status in neoadjuvant treatment for pancreatic cancer. J Hepatobiliary Pancreat Sci 22:563–570CrossRefPubMed

28.

National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology. Pancreatic adenocarcinoma. Version 2 (2013)

29.

Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216CrossRefPubMed

30.

Evans DB, Rich TA, Byrd DR et al (1992) Preoperative chemoradiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas. Arch Surg 127:1335–1339CrossRefPubMed

31.

Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474CrossRefPubMed

32.

Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumours, 7th edn. Wiley-Liss, New York

33.

Sho M, Tanaka T, Yamada T et al (2011) Novel postoperative adjuvant strategy prevents early hepatic recurrence after resection of pancreatic cancer. J Hepatobiliary Pancreat Sci 18:235–239 discussion 239–240 CrossRefPubMed

34.

Prado CM, Lieffers JR, McCargar LJ et al (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9:629–635CrossRefPubMed

35.

Shen W, Punyanitya M, Wang Z et al (2004) Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol 97:2333–2338CrossRefPubMed

36.

Strandberg S, Wretling ML, Wredmark T et al (2010) Reliability of computed tomography measurements in assessment of thigh muscle cross-sectional area and attenuation. BMC Med Imaging 10:18PubMedCentralCrossRefPubMed

37.

Valle JW, Palmer D, Jackson R et al (2014) Optimal duration and timing of adjuvant chemotherapy after definitive surgery for ductal adenocarcinoma of the pancreas: ongoing lessons from the ESPAC-3 study. J Clin Oncol 32:504–512CrossRefPubMed

38.

Palmer DH, Stocken DD, Hewitt H et al (2007) A randomized phase 2 trial of neoadjuvant chemotherapy in resectable pancreatic cancer: gemcitabine alone versus gemcitabine combined with cisplatin. Ann Surg Oncol 14:2088–2096CrossRefPubMed

39.

Goodpaster BH, Theriault R, Watkins SC et al (2000) Intramuscular lipid content is increased in obesity and decreased by weight loss. Metabolism 49:467–472CrossRefPubMed

40.

Goodpaster BH, Thaete FL, Simoneau JA et al (1997) Subcutaneous abdominal fat and thigh muscle composition predict insulin sensitivity independently of visceral fat. Diabetes 46:1579–1585CrossRefPubMed

41.

Pan DA, Lillioja S, Kriketos AD et al (1997) Skeletal muscle triglyceride levels are inversely related to insulin action. Diabetes 46:983–988CrossRefPubMed

42.

Arends J, Bodoky G, Bozzetti F et al (2006) ESPEN Guidelines on Enteral Nutrition: non-surgical oncology. Clin Nutr 25:245–259CrossRefPubMed

Title: Prognostic Significance of Muscle Attenuation in Pancreatic Cancer Patients Treated with Neoadjuvant Chemoradiotherapy
Authors: Takahiro Akahori
Masayuki Sho
Shoichi Kinoshita
Minako Nagai
Satoshi Nishiwada
Toshihiro Tanaka
Tetsuro Tamamoto
Chiho Ohbayashi
Masatoshi Hasegawa
Kimihiko Kichikawa
Yoshiyuki Nakajima
Publication date: 01-12-2015
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 12/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-015-3205-3

At a glance: The STEP trials

Springer Medicine

Prognostic Significance of Muscle Attenuation in Pancreatic Cancer Patients Treated with Neoadjuvant Chemoradiotherapy

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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