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Cited by 54Nutrition and Health in AgingPancreatic and Hepatic Oncology ResearchInflammatory Biomarkers in Disease Prognosis

Cachectic Body Composition and Inflammatory Markers Portend a Poor Prognosis in Patients with Locally Advanced Pancreatic Cancer Treated with Chemoradiation

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Naumann, Patrick, Eberlein, Jonathan, Farnia, Benjamin, Liermann, Jakob, Hackert, Thilo, Debus, Jürgen, Combs, Stephanie E.·2019·Cancers
DOI 10.3390/cancers11111655PMC PMC6895786
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Abstract

Background: Patients with pancreatic cancer often develop cancer cachexia, a complex multifactorial syndrome with weight loss, muscle wasting and adipose tissue depletion with systemic inflammation causing physical impairment. In patients with locally advanced pancreatic cancer (LAPC) neoadjuvant treatment is routinely performed to allow a subsequent resection. Herein, we assess body composition and laboratory markers for cancer cachexia both before and after neoadjuvant chemoradiation (CRT). Methods: Subcutaneous fat (SCF), visceral fat (VF), skeletal muscle (SM), weight and laboratory parameters were determined longitudinally in 141 LAPC patients treated with neoadjuvant CRT. Changes during CRT were statistically analyzed and correlated with outcome and Kaplan–Meier curves were plotted. Different prognostic factors linked to cachexia were assessed by uni- and multivariable cox proportional hazards models. Results: There was a significant decrease in weight as well as SCF, VF and SM during CRT. The laboratory parameter C-reactive protein (CRP) increased significantly, whereas there was a significant decrease in leukocyte count, hemoglobin, albumin and cholinesterase as well as in the tumor marker CA 19.9. Cachectic weight loss, sarcopenia, reductions in body compartments SCF, VF and SM, and changes in laboratory markers as well as resection affected survival in univariable analysis. In multivariable analysis, weight loss >5% (HR 2.8), reduction in SM >5% (HR 5.5), an increase in CRP (HR 2.2) or CA 19.9 (HR 1.9), and resection (HR 0.4) remained independently associated with survival, whereas classical cachexia and sarcopenia did not. Interestingly, the subgroup of patients with cachectic weight loss >5% or SM reduction >5% during CRT did not benefit from resection (median survival 12 vs. 27 months). Conclusions: Persistent weight loss and muscle depletion during CRT as well as systemic inflammation after CRT impacted survival more than cachexia or sarcopenia according classical definitions.

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  • With further progression, CT is used for more in-depth analysis of body composition changes.

    “With further progression, computer tomography (CT) is used for more in-depth analysis of body composition changes [35].”

    From The Utility of Body Composition Assessment in Nutrition and Clinical Practice: An Overview of Current Methodology (2021) · cites this paper as [35]

    Results §2.1 and Methods §4.2 describe using CT scans before and after chemoradiation to measure changes in fat and skeletal muscle. They support CT-based analysis of body composition, but do not say that further disease progression prompts that analysis; the second scan was taken at the first post-treatment follow-up. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

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Authors
Naumann, P., Eberlein, J., Farnia, B., Liermann, J., Hackert, T., Debus, J., & Combs, S. E.
Affiliations
  • German Cancer Research Center (DE)
  • University Hospital Heidelberg (DE)
  • University of Miami (US)
  • Helmholtz Munich (DE)
Corresponding author
Naumann, Patrick
ORCID
Venue
Cancers
Publisher
MDPI AG
Published
2019-10-26
Volume
11
Issue
11
Pages
1655
ISSN
2072-6694 (ISSN-L)
DOI
10.3390/cancers11111655
PMC
PMC6895786
OpenAlex
W2981899099
Cited by
54
References
3
Citations by year
2026: 3 · 2025: 3 · 2024: 4 · 2023: 6 · 2022: 14 · 2021: 16 · 2020: 8
FWCI
6.52
Type
journal article
Language
en
Open access
Licence
Locations
  • Cancers (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion, other-oa)
  • mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
  • Site cant be reached (submittedVersion, cc-by)
  • PuSH - Publication Server of Helmholtz Zentrum München (submittedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
  • Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
Keywords
pancreatic cancer, cancer cachexia, body composition, neoadjuvant chemoradiotherapy, locally advanced pancreatic cancer, sarcopenia, weight loss, visceral fat, subcutaneous adipose tissue, C-reactive protein, systemic inflammation, CA19-9, prognostic factors, survival, pancreatic resection

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