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  • br Total body fat mass FM

    2021-03-10


    Total body fat mass (FM) (kg) ¼ 0.042 x [ total adipose area at L3] þ 11.2 Total body fat-free mass(FFM) (kg) ¼ 0.3 x [ Erastin area at L3] þ 6.06 Total body skeletal muscle volume was then estimated using the regression equation developed by Shen and colleagues [13]. A density of 1.04 g/ml was subsequently applied to estimate skeletal muscle mass from volume [14]. Changes in total skeletal mass are expressed in changes per hundred days to account for any potential variation in the timing of CT imaging between patients.
    Cancer cachexia was staged using the International Consensus Classification as either [11]:
    1) Involuntary weight loss > 5% in the last 6 months in the absence of simple starvation
    BMI was categorised as per World Health Organisation (WHO) classification (REF).
    Statistical analysis
    Statistical analysis was conducted using SPSS (IBM SPSS Statis-tics version 24, Chicago, Illinois, USA). Data were expressed using mean ± standard deviation (SD) or median ± interquartile range (IQR) as appropriate following assessment of distribution. Differ-ences between groups were assessed using Mann-Whitney or in-dependent t tests for continuous variables, while chi-square tests were used to compare categorical variables. Paired t-tests were used to examine sequential changes in body composition mea-surement. Overall survival (OS) was calculated from the date of MDT decision to treat until the date of death or censor (December 31st, 2017). Associations between relevant clinical and anthropo-metric variables was assessed using Cox proportional hazard models. Backward stepwise selection was used to identify variables for the multivariable model, and results were reported as hazard ratios (HR) with 95% Confidence Intervals.
    Ethical approval was obtained from St Vincent's Healthcare Group Ethics and Medical Research Committee prior to undertak-ing this study.
    Results
    Of 100 patients diagnosed with BRPC between 2012 and 2015, 78 had both a CT suitable for body composition analysis, and necessary anthropometric details required for inclusion. Baseline characteristics and treatment-related variables are described in Table 1. Following neo-adjuvant therapy 67patients were re-staged. 50 (64%) went on to receive radiotherapy, after which 25 (32%) were considered to have a either a clinical response or stable dis-ease and underwent resection.
    Please cite this article as: Griffin OM et al., Characterising the impact of body composition change during neoadjuvant chemotherapy for pancreatic cancer, Pancreatology, https://doi.org/10.1016/j.pan.2019.07.039
    O.M. Griffin et al. / Pancreatology xxx (xxxx) xxx 3
    Table 1
    Patient characteristics and treatment variables (N ¼ 78).
    Age (years)a
    Male Gender
    Biliary Obstruction
    Pancreatitis
    Diabetes
    b
    b
    Chemotherapy Agent
    None (Patient declined/rapid deterioration) 3 (4)
    Folfirinox
    Gemcitabine þ Nab-Paclitaxel
    Gemcitabine (single agent)
    Gemcitabine þ Oxaliplatin
    Gemcitabine þ Cis/Carboplatin
    Treatment outcome
    Crisis admission required (n ¼
    b
    Survival (days)
    Survival (months)b
    Nutrition Parameters at Diagnosis (n ¼
    a
    Body Mass Index
    Percentage weight lossb
    Sarcopenia
    Cachexia
    Low muscle attenuation
    Adjuvant chemotherapy
    Fig. 1. BMI distribution of Sarcopenic Patients.
    skeletal muscle 24.1 kg vs 24.2 kg p ¼ 0.93, muscle attenuation 35.8HU vs 33.6HU P ¼ 0.234). Fewer than half (43%) of the study group had been prescribed pancreatic enzyme replacement ther-apy (PERT) to treat pancreatic exocrine insufficiency (PEI). Patients who had been prescribed PERT had presented with a higher base-line weight loss (10% vs 5.3%, P ¼ 0.011), while there was no dif-ference in baseline body composition.
    The change in body composition from baseline to post-chemotherapy treatment in the 67 patients with an available post-treatment CT scan was assessed. The median (IQR) interval between CT scans was 182 days (72e316), and the median (IQR) muscle loss per hundred days was 1.3 kg ( 8.3 e þ4.0). All body composition parameters, except muscle attenuation, deteriorated during treatment (Table 2). The majority of patients (73%) experi-enced loss of lean tissue (SMI, fat-free mass, skeletal muscle mass) during treatment.
    Please cite this article as: Griffin OM et al., Characterising the impact of body composition change during neoadjuvant chemotherapy for pancreatic cancer, Pancreatology, https://doi.org/10.1016/j.pan.2019.07.039
    4 O.M. Griffin et al. / Pancreatology xxx (xxxx) xxx
    Table 2
    Body composition changes during neo-adjuvant chemotherapy.
    Diagnostic CT Post- chemotherapy CT p- value