Hepatobiliary & pancreatic diseases international : HBPD INT · 2026
Progression of sarcopenia among patients with pancreatic ductal adenocarcinoma receiving neoadjuvant therapy and the impact of pancreatic enzyme replacement therapy.
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Anand Jyotsna, Hodson James, Pande Rupaly, Roberts Keith J
Аннотация
BACKGROUND: Neoadjuvant therapy (NAT) is increasingly used among patients with pancreatic ductal adenocarcinoma (PDAC). Patients with PDAC commonly present with sarcopenia, which may progress during the period of NAT and subsequently impact treatment outcomes. However, data assessing trends in sarcopenia are currently lacking. As such, this audit sought to quantify changes in body composition during NAT, and to assess whether these correlated with patient outcomes or pancreatic enzyme replacement therapy (PERT) usage.
METHODS: Computed tomography (CT) scans performed pre- and post-NAT were analyzed to assess measures of sarcopenia, namely the psoas muscle index (PMI) and intramuscular adipose content of the multifidus (IMAC; a proxy for muscle function), and measures of adiposity, namely the cross-sectional areas of subcutaneous adipose tissue and visceral adipose tissue (SAT/VAT). Associations between the changes in these measures and surgical resection rates, survival and PERT usage were then assessed.
RESULTS: Among 100 patients receiving NAT, all four measures of body composition were found to be decreased significantly between the pre- and post-NAT CT scans, with these reductions being significantly greater in patients who did not subsequently undergo surgical resection. In patients undergoing resection, larger reductions in PMI (P = 0.007) and SAT (P = 0.043) were associated with significantly shorter survival. PERT was associated with significantly smaller reductions in PMI (mean: 0.50 vs. 0.89 cm2/m2, P = 0.046), as well as significantly longer survival in resected patients (hazard ratio: 0.47, 95% CI: 0.22-0.98, P = 0.045).
CONCLUSIONS: This audit demonstrates that the progression of sarcopenia during NAT, which could preclude surgical resection of PDAC, is a crucial prognostic factor for survival in this setting. PERT may mitigate sarcopenia progression and improve survival in resected patients.
METHODS: Computed tomography (CT) scans performed pre- and post-NAT were analyzed to assess measures of sarcopenia, namely the psoas muscle index (PMI) and intramuscular adipose content of the multifidus (IMAC; a proxy for muscle function), and measures of adiposity, namely the cross-sectional areas of subcutaneous adipose tissue and visceral adipose tissue (SAT/VAT). Associations between the changes in these measures and surgical resection rates, survival and PERT usage were then assessed.
RESULTS: Among 100 patients receiving NAT, all four measures of body composition were found to be decreased significantly between the pre- and post-NAT CT scans, with these reductions being significantly greater in patients who did not subsequently undergo surgical resection. In patients undergoing resection, larger reductions in PMI (P = 0.007) and SAT (P = 0.043) were associated with significantly shorter survival. PERT was associated with significantly smaller reductions in PMI (mean: 0.50 vs. 0.89 cm2/m2, P = 0.046), as well as significantly longer survival in resected patients (hazard ratio: 0.47, 95% CI: 0.22-0.98, P = 0.045).
CONCLUSIONS: This audit demonstrates that the progression of sarcopenia during NAT, which could preclude surgical resection of PDAC, is a crucial prognostic factor for survival in this setting. PERT may mitigate sarcopenia progression and improve survival in resected patients.