The impact of sarcopenia and decrease in skeletal muscle mass in patients with advanced pancreatic cancer during FOLFIRINOX therapy

摘要

Sarcopenia, defined as decrease in skeletal muscle mass (SMM) and strength, might be associated with reduced survival. We investigated the impact of sarcopenia and decrease in SMM in patients with advanced pancreatic cancer during FOLFIRINOX (FX) therapy. Consecutive sixty-nine patients who received FX were evaluated. Skeletal muscle index (SMI) (cm(2)/m(2)) was used to evaluate SMM. The cut-off value of sarcopenia was defined as SMI <42 for males and <38 for females, based on the Asian Working Group for sarcopenia criteria. Sarcopenia was diagnosed in thirty-three (48 %) subjects. Comparison of baseline characteristics of the two groups (sarcopenia group: non-sarcopenia group) showed a significant difference in sex, tumour size and BMI. There was no significant difference in the incidence of adverse events with grades 3-5 and progression-free survival (PFS) during FX between the two groups (PFS 8 center dot 1 and 8 center dot 8 months; P = 0 center dot 88). On the multivariate analysis, progressive disease at the first follow-up computed tomography (hazard ratio (HR) 3 center dot 87, 95 % CI 1 center dot 53, 9 center dot 67), decreased SMI >= 7 center dot 9 % in 2 months (HR 4 center dot 02, 95 % CI 1 center dot 87, 8 center dot 97) and carcinoembryonic antigen >= 4 center dot 6 (HR 2 center dot 52, 95 % CI 1 center dot 10, 6 center dot 11) were significant risk factors associated with poor overall survival (OS), but sarcopenia at diagnosis was not. OS in patients with decreased SMI of >= 7 center dot 9 % and <7 center dot 9 % were 10 center dot 9 and 21 center dot 0 months (P < 0 center dot 01), respectively. In conclusion, decrease in SMM within 2 months after the initiation of chemotherapy had significantly shorter OS, although sarcopenia at diagnosis did not affect OS. Therefore, it might be important to maintain SMM during chemotherapy for a better prognosis.