ASPO Abstracts
Body composition changes after diagnosis and survival of patients with advanced pancreatic cancer
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research, Lifestyles Behavior, Energy Balance & Chemoprevention
Conference Year: 2018
Abstract Body:
Body composition changes resulting in loss of muscle tissue (sarcopenia) and weight loss are a hallmark of pancreatic cancer. Although they result in reduced quality of life, their association with patient survival is not well understood. We evaluated whether post-diagnosis change in muscle and adipose tissue correlates with patient survival. Furthermore, we have previously shown that breakdown of muscle tissue occurring early in the disease results in increased plasma levels of branched-chain amino acids (BCAA). Here we investigate whether BCAA levels at diagnosis are associated with subsequent loss of muscle tissue. Muscle, visceral and subcutaneous adipose tissue areas were measured using computed tomography (CT) imaging. Measurements were performed on baseline CT scans and on follow-up CT scans, obtained 50-120 days later, in 89 pancreatic cancer patients with locally advanced and metastatic disease. Association between body composition change and survival was evaluated using multivariate Cox proportional hazards model. Between the diagnostic and the follow-up scan, patients lost on average 11.4 ± 12.3% of muscle area, 17.0 ± 21.6% of subcutaneous fat, and 7.1 ± 76.5% of visceral fat. Compared to patients in top quartile of muscle area change (average gain of 0.2 ± 2.9 cm2), those in the lowest quartile (average loss of 13.2 ± 4.4 cm2) had a 3.3-fold increase in mortality (HR=3.29, 95% CI: 1.26-8.85). We observed a 2.9-fold increase in mortality among patients in the bottom quartile of visceral fat change (average loss of 29.0 ± 14.9 cm2), compared to those in the top quartile (average gain of 7.2 ± 9.9 cm2) (HR=2.93, 95% CI: 1.25-6.86). There was no association between loss of subcutaneous fat and patient survival. Compared to patients in the lowest tertile of total BCAA levels, those in the highest tertile lost more muscle (P=0.004). In conclusion, greater post-diagnosis loss of muscle and visceral fat area was associated with large reduction in patient survival. Plasma levels of BCAA could potentially serve as a biomarker for identifying patients at risk of developing greater loss of muscle area. Our findings warrant further studies in larger populations of pancreatic cancer patients.
Keywords: Sarcopenia, pancreatic cancer, biomarkers, body composition