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Characterization of Anthropometric Changes that Occur During Neoadjuvant Therapy for Potentially Resectable Pancreatic Cancer

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Little is known about changes in body composition that may occur during neoadjuvant therapy for pancreatic cancer. This study was designed to characterize these changes and their potential relationships with therapeutic outcomes.

Methods

The study population consisted of patients with potentially resectable pancreatic cancer treated on a phase II trial of neoadjuvant chemotherapy and chemoradiation. Skeletal muscle and adipose tissue compartments were measured before and after administration of neoadjuvant therapy using SliceOMatic software (TomoVision, 2012) and protocol-mandated CT scans. Sarcopenia was defined using gender-adjusted norms.

Results

Among 89 eligible patients, 46 (52 %) patients met anthropometric criteria for sarcopenia prior to the initiation of neoadjuvant therapy. Further depletion of skeletal muscle, visceral adipose tissue, and subcutaneous adipose tissue occurred during neoadjuvant therapy, but these losses did not preclude the performance of potentially curative surgery. Degree of skeletal muscle loss correlated with disease-free survival while visceral adipose loss was associated with overall and progression-free survival. However, completion of all therapy, including pancreatectomy, was the only independently significant predictor of outcome in a multivariate analysis of overall survival.

Discussion

These data suggest that body composition analysis of standard CT images may provide clinically relevant information for patients with potentially resectable pancreatic cancer who receive neoadjuvant therapy. Anthropometric changes must be considered in the design of preoperative therapy regimens, and further efforts should focus on maintenance of muscle and visceral adipose tissue in the preoperative setting.

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Acknowledgment

Supported by the Khalifa Bin Zayed Al Nahyan Foundation and by the Various Donor Pancreatic Research Fund at the University of Texas MD Anderson Cancer Center. ABC is also supported by a grant from the Foundation of Surgical Fellowships. RS is part of the Biostatistics Shared Resource supported by the NIH/NCI under award number P30CA016672.

Disclosures

There are no relevant financial disclosures.

Author information

Authors and Affiliations

  1. Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA

    Amanda B. Cooper MD, MS

  2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Rebecca Slack MS

  3. Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    David Fogelman MD & Gauri Varadhachary MD

  4. Healthy Aging Clinic and General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Holly M. Holmes MD

  5. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77230-1402, USA

    Maria Petzel RD, Nathan Parker MS, Jeffrey E. Lee MD, Thomas Aloia MD, Claudius Conrad MD, Jean-Nicolas Vauthey MD, Jason B. Fleming MD & Matthew H. G. Katz MD

  6. Department of Clinical Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Maria Petzel RD

  7. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Aparna Balachandran MD & Naveen Garg MD

  8. Department of Rehabilitative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    An Ngo-Huang

  9. Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA

    Douglas B. Evans MD

Authors
  1. Amanda B. Cooper MD, MS
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  2. Rebecca Slack MS
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  3. David Fogelman MD
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  4. Holly M. Holmes MD
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  5. Maria Petzel RD
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  6. Nathan Parker MS
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  7. Aparna Balachandran MD
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  9. An Ngo-Huang
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  10. Gauri Varadhachary MD
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  11. Douglas B. Evans MD
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  12. Jeffrey E. Lee MD
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  13. Thomas Aloia MD
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  14. Claudius Conrad MD
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  15. Jean-Nicolas Vauthey MD
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  16. Jason B. Fleming MD
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  17. Matthew H. G. Katz MD
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Corresponding author

Correspondence to Matthew H. G. Katz MD.

Electronic supplementary material

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10434_2014_4285_MOESM1_ESM.tif

Figure S1. Anthropometric analysis. The cross sectional areas of the skeletal muscle (red), subcutaneous adipose tissue (light blue) and visceral adipose tissue (dark blue) compartments were computed using CT images obtained as part of routine care, and were standardized to the square of the height in meters. Supplementary material 1 (TIFF 831 kb)

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Cooper, A.B., Slack, R., Fogelman, D. et al. Characterization of Anthropometric Changes that Occur During Neoadjuvant Therapy for Potentially Resectable Pancreatic Cancer. Ann Surg Oncol 22, 2416–2423 (2015). https://doi.org/10.1245/s10434-014-4285-2

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  • DOI: https://doi.org/10.1245/s10434-014-4285-2

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