Prognostic value of early changes in CT-measured body composition in patients receiving chemotherapy for unresectable pancreatic cancer
Prognostic value of early changes in CT-measured body composition in patients receiving chemotherapy for unresectable pancreatic cancer
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DOI：
10.1007/s00330-021-07899-6
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发表时间：
2021-05-02
影响因子：
5.9
通讯作者：
Haider, Masoom A.
中科院分区：
文献类型：
--
作者：
Salinas-Miranda, Emmanuel;Deniffel, Dominik;Haider, Masoom A.
目的探讨胰腺导管腺癌（PDAC）患者的预后因素。然而，目前尚不清楚身体成分的变化是否为已确定的风险因素提供了增量预后价值，特别是实体瘤疗效评价标准版本1.1（RECISTv1.1）。本研究的目的是确定CT量化的身体成分变化对开始化疗的不可切除PDAC患者的预后价值。方法我们回顾性评估了105例不可切除（局部晚期或转移性）PDAC患者，在一项多中心前瞻性试验中接受FOLFIRINOX（n = 64）或基于吉西他滨（n = 41）的一线化疗。评估化疗前和首次随访CT之间骨骼肌指数（SMI）、皮下（SATI）和内脏脂肪组织指数（VATI）的变化（Delta）。使用考克斯回归模型和协变量校正的生存曲线来确定总生存期（OS）的预测因子。结果在多变量分析中，调整第一次随访时的RECISTv1.1反应，Delta SMI是OS的预后，风险比（HR）为1.2（95% CI：1.08-1.33，p = 0.001）。未观察到Delta SATI（HR：1，95% CI：0.97-1.04，p = 0.88）和Delta VATI（HR：1.01，95% CI：0.99-1.04，p = 0.33）与OS的显著相关性。以2.8 cm 2/m2/30天为最佳临界值，高与低Delta SMI患者的中位生存期分别为143天与233天（p < 0.001）。结论：首次随访时骨骼肌丢失率较低的患者，无论其RECISTv1.1-分类如何，不可切除PDAC的生存率均有所提高。除了常规的放射学评估外，在首次随访CT时评估Delta SMI可能有助于诊断。
Objectives Skeletal muscle mass is a prognostic factor in pancreatic ductal adenocarcinoma (PDAC). However, it remains unclear whether changes in body composition provide an incremental prognostic value to established risk factors, especially the Response Evaluation Criteria in Solid Tumors version 1.1 (RECISTv1.1). The aim of this study was to determine the prognostic value of CT-quantified body composition changes in patients with unresectable PDAC starting chemotherapy. Methods We retrospectively evaluated 105 patients with unresectable (locally advanced or metastatic) PDAC treated with FOLFIRINOX (n = 64) or gemcitabine-based (n = 41) first-line chemotherapy within a multicenter prospective trial. Changes (Delta) in skeletal muscle index (SMI), subcutaneous (SATI), and visceral adipose tissue index (VATI) between pre-chemotherapy and first follow-up CT were assessed. Cox regression models and covariate-adjusted survival curves were used to identify predictors of overall survival (OS). Results At multivariable analysis, adjusting for RECISTv1.1-response at first follow-up, Delta SMI was prognostic for OS with a hazard ratio (HR) of 1.2 (95% CI: 1.08-1.33, p = 0.001). No significant association with OS was observed for Delta SATI (HR: 1, 95% CI: 0.97-1.04, p = 0.88) and Delta VATI (HR: 1.01, 95% CI: 0.99-1.04, p = 0.33). At an optimal cutoff of 2.8 cm(2)/m(2) per 30 days, the median survival of patients with high versus low Delta SMI was 143 versus 233 days (p < 0.001). Conclusions Patients with a lower rate of skeletal muscle loss at first follow-up demonstrated improved survival for unresectable PDAC, regardless of their RECISTv1.1-category. Assessing Delta SMI at the first follow-up CT may be useful for prognostication, in addition to routine radiological assessment.