The Differential Clinical Impacts of Cachexia and Sarcopenia on the Prognosis of Advanced Pancreatic Cancer
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Clinical Informatics Collection and CC or SC Definition
2.2. Computed Tomography (CT) Image Analysis and TPA Index Calculation
2.3. Overlap Assessment of CC, SC, and Their Associated Factors
2.4. Statistical Analysis
3. Results
3.1. Survival Rates in Advanced PC Patients According to Clinical and Pathological Characteristics
3.2. Comparison of Survival Outcomes among Advanced PC Patients, Patients with C/T Treatment or High BMI Values Stratified by CC or SC Status
3.3. Comparison of Clinical Characteristics and Significance Levels Based on CC and SC
3.4. Prognostic Significance of Clinical Factors and CC or SC Presence
3.5. Overlaps among CC, SC, and Their Associated Factors in Advanced PC
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
BMI | body mass index |
C/T | chemotherapy |
C/T + local R/T | combined chemotherapy and local radiotherapy |
CA19-9 | carbohydrate antigen 19-9 |
CC | cancer cachexia |
CI | confidence interval |
CS + adj | conversion surgery with pre- or post-operative adjuvant chemotherapy |
CT | computed tomography |
EMRs | electronic medical records |
Hb | hemoglobin |
HR | hazard ratio |
HU | hounsfield unit |
IRB | Institutional Review Board |
L3 | the third lumbar vertebrae |
mOS | median overall survival |
mPFS | median progression-free survival |
Non-CC | negative cancer cachexia status |
Non-SC | negative sarcopenia status |
OR | odds ratio |
OS | overall survival |
PC | pancreatic cancer |
PFS | progression-free survival |
SC | sarcopenia |
SO | sarcopenic obesity |
TPA | total psoas area |
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Variable | Patients (%) | Overall Survival | Progression-Free Survival | ||
---|---|---|---|---|---|
Median (Months) | p Value | Median (Months) | p Value | ||
Age | |||||
≤65 years | 139 (59.9) | 10.580 | 0.114 | 6.110 | 0.254 |
>65 years | 93 (40.1) | 8.310 | 7.000 | ||
Gender | |||||
Male | 149 (64.2) | 10.220 | 0.853 | 6.930 | 0.147 |
Female | 83 (35.8) | 10.090 | 5.880 | ||
Stage | |||||
III | 60 (25.9) | 14.920 | 0.000 | 8.480 | 0.050 |
IV | 172 (74.1) | 8.610 | 6.470 | ||
Tumor location | |||||
Head/neck/uncinate process | 93 (40.1) | 10.150 | 0.880 | 6.830 | 0.774 |
Body/tail | 139 (59.9) | 10.120 | 6.110 | ||
Tumor grade | |||||
Well diff. | 15 (6.5) | 11.990 | 0.426 | 6.540 | 0.968 |
Moderately diff. | 85 (36.6) | 11.070 | 6.800 | ||
Poorly diff. | 43 (18.5) | 8.110 | 6.670 | ||
Unknown | 89 (38.4) | 10.220 | 6.700 | ||
Treatment | |||||
CS + adj | 24 (10.3) | 25.590 | 0.000 | 9.430 | 0.039 |
C/T | 172 (74.1) | 8.310 | 6.080 | ||
C/T + local R/T | 36 (15.5) | 11.560 | 5.950 | ||
CA19-9 | |||||
≤100 U/mL | 72 (31.0) | 12.160 | 0.019 | 6.970 | 0.067 |
>100 U/ml | 160 (69.0) | 9.170 | 6.670 | ||
BMI | |||||
≤22 kg/m2 | 116 (50.0) | 11.700 | 0.006 | 6.900 | 0.181 |
>22 kg/m2 | 116 (50.0) | 8.310 | 5.880 | ||
Hemoglobin | |||||
≤12 g/dL | 90 (38.8) | 8.280 | 0.002 | 5.950 | 0.258 |
>12 g/dL | 142 (61.2) | 12.160 | 6.930 | ||
Albumin | |||||
≤3.5 g/dL | 69 (29.7) | 5.720 | 0.000 | 7.260 | 0.859 |
>3.5 g/dL | 163 (70.3) | 12.910 | 6.540 |
Variable | Cancer Cachexia (%) | Sarcopenia (%) | ||||
---|---|---|---|---|---|---|
No (n = 38) | Yes (n = 194) | p Value | No (n = 118) | Yes (n = 114) | p Value | |
Age | ||||||
≤65 years | 24 (63.2) | 115 (59.3) | 0.655 | 85 (72.0) | 54 (47.4) | 0.000 |
>65 years | 14 (36.8) | 79 (40.7) | 33 (28.0) | 60 (52.6) | ||
Gender | ||||||
Male | 25 (65.8) | 124 (63.9) | 0.826 | 84 (71.2) | 65 (57.0) | 0.024 |
Female | 13 (34.2) | 70 (36.1) | 34 (28.8) | 49 (43.0) | ||
Stage | ||||||
III | 5 (13.2) | 55 (28.4) | 0.051 | 28 (23.7) | 32 (28.1) | 0.450 |
IV | 33 (86.8) | 139 (71.6) | 90 (76.3) | 82 (71.9) | ||
Tumor location | ||||||
Head/neck/uncinate process | 15 (39.5) | 78 (40.2) | 0.933 | 44 (37.3) | 49 (43.0) | 0.376 |
Body/tail | 23 (60.5) | 116 (59.8) | 74 (62.7) | 65 (57.0) | ||
Tumor grade | ||||||
Well diff. | 2 (5.3) | 13 (6.7) | 0.461 | 9 (7.6) | 6 (5.3) | 0.902 |
Moderately diff. | 18 (47.4) | 67 (34.5) | 43 (36.4) | 42 (36.8) | ||
Poorly diff. | 7 (18.4) | 36 (18.6) | 22 (18.6) | 21 (18.4) | ||
Unknown | 11 (28.9) | 78 (40.2) | 44 (37.3) | 45 (39.5) | ||
Treatment | ||||||
CS + adj | 3 (7.9) | 21 (10.8) | 0.544 | 13 (11.0) | 11 (9.6) | 0.197 |
C/T | 27 (71.1) | 145 (74.7) | 82 (69.5) | 90 (78.9) | ||
C/T + local R/T | 8 (21.1) | 28 (14.4) | 23 (19.5) | 13 (11.4) | ||
CA19-9 | ||||||
≤100 U/mL | 13 (34.2) | 59 (30.4) | 0.644 | 37 (31.4) | 35 (30.7) | 0.914 |
>100 U/mL | 25 (65.8) | 135 (69.6) | 81 (68.6) | 79 (69.3) | ||
BMI | ||||||
≤22 kg/m2 | 19 (50.0) | 97 (50.0) | 1.000 | 48 (40.7) | 68 (59.6) | 0.004 |
>22 kg/m2 | 19 (50.0) | 97 (50.0) | 70 (59.3) | 46 (40.4) | ||
Hemoglobin | ||||||
≤12 g/dL | 8 (21.1) | 82 (42.3) | 0.014 | 38 (32.2) | 52 (45.6) | 0.036 |
>12 g/dL | 30 (78.9) | 112 (57.7) | 80 (67.8) | 62 (54.4) | ||
Albumin | ||||||
≤3.5 g/dL | 9 (23.7) | 60 (30.9) | 0.372 | 23 (19.5) | 46 (40.4) | 0.001 |
>3.5 g/dL | 29 (76.3) | 134 (69.1) | 95 (80.5) | 68 (59.6) |
Variable | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
OR (95% CI) | p Value | OR (95% CI) | p Value | |
Factor influencing cancer cachexia | ||||
Hemoglobin (≤12/>12 g/dL) | 2.746 (1.197–6.298) | 0.017 | 2.718 (1.156–6.391) | 0.022 |
Factors influencing sarcopenia | ||||
Age (>65/≤65 years) | 2.862 (1.660–4.935) | 0.000 | 2.745 (1.534–4.913) | 0.001 |
Gender (female/male) | 1.862 (1.081–3.210) | 0.025 | 1.450 (0.797–2.637) | 0.224 |
BMI (≤22/>22 kg/m2) | 2.156 (1.276–3.642) | 0.004 | 2.492 (1.409–4.405) | 0.002 |
Hemoglobin (≤12/>12 g/dL) | 1.766 (1.035–3.011) | 0.037 | 1.396 (0.770–2.531) | 0.271 |
Albumin (≤3.5/>3.5 g/dL) | 2.794 (1.550–5.038) | 0.001 | 2.648 (1.401–5.004) | 0.003 |
Variable | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
HR (95% CI) | p Value | HR (95% CI) | p Value | |
Overall Survival | ||||
Stage (IV/III) | 1.837 (1.321–2.556) | 0.000 | 1.744 (1.240–2.453) | 0.001 |
Treatment (C/T/CS + adj) | 3.685 (1.941–6.996) | 0.000 | 3.214 (1.678–6.157) | 0.000 |
Treatment (C/T + local R/T/CS + adj) | 2.702 (1.334–5.472) | 0.006 | 1.964 (0.958–4.025) | 0.065 |
CA19-9 (>100/≤100 U/mL) | 1.442 (1.059–1.963) | 0.020 | 1.336 (0.971–1.839) | 0.075 |
BMI (>22/≤22 kg/m2) | 1.478 (1.118–1.956) | 0.006 | 1.656 (1.240–2.211) | 0.001 |
Hemoglobin (≤12/>12 g/dL) | 1.555 (1.170–2.065) | 0.002 | 1.305 (0.972–1.752) | 0.076 |
Albumin (≤3.5/>3.5 g/dL) | 2.508 (1.855–3.390) | 0.000 | 2.330 (1.693–3.207) | 0.000 |
CC (yes/no) in all patients | 1.738 (1.176–2.568) | 0.006 | 2.232 (1.474–3.379) | 0.000 |
SC (yes/no) in all patients | 1.256 (0.951–1.660) | 0.108 | 1.210 (0.908–1.613) | 0.193 |
CC (yes/no) in patients with C/T | 2.001 (1.256–3.189) | 0.004 | 2.037 (1.273–3.261) | 0.003 |
SC (yes/no) in patients with C/T | 1.517 (1.104–2.085) | 0.010 | 1.533 (1.116–2.106) | 0.008 |
CC (yes/no) in patients with BMI > 22 | 1.840 (1.075–3.151) | 0.026 | 1.919 (1.112–3.313) | 0.019 |
SC (yes/no) in patients with BMI > 22 | 1.488 (1.001–2.212) | 0.049 | 1.537 (1.035–2.282) | 0.033 |
Progression-Free Survival | ||||
Stage (IV/III) | 1.426 (0.997–2.040) | 0.052 | 1.465 (1.005–2.135) | 0.047 |
Treatment (C/T/CS + adj) | 1.877 (1.104–3.193) | 0.020 | 1.678 (0.969–2.906) | 0.065 |
Treatment (C/T + local R/T/CS + adj) | 2.076 (1.138–3.785) | 0.017 | 1.795 (0.976–3.303) | 0.060 |
CA19-9 (>100/≤100 U/mL) | 1.388 (0.975–1.975) | 0.069 | 1.356 (0.950–1.937) | 0.094 |
CC (yes/no) in all patients | 1.586 (1.026–2.451) | 0.038 | 1.723 (1.103–2.692) | 0.017 |
SC (yes/no) in all patients | 1.107 (0.805–1.523) | 0.531 | 1.094 (0.793–1.510) | 0.583 |
CC (yes/no) in patients with C/T | 2.212 (1.247–3.923) | 0.007 | 2.183 (1.230–3.874) | 0.008 |
SC (yes/no) in patients with C/T | 1.233 (0.836–1.817) | 0.290 | 1.189 (0.807–1.752) | 0.382 |
CC (yes/no) in patients with BMI > 22 | 2.187 (1.084–4.409) | 0.029 | 2.164 (1.073–4.363) | 0.031 |
SC (yes /no) in patients with BMI > 22 | 1.237 (0.774–1.976) | 0.373 | 1.208 (0.756–1.930) | 0.430 |
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Hou, Y.-C.; Chen, C.-Y.; Huang, C.-J.; Wang, C.-J.; Chao, Y.-J.; Chiang, N.-J.; Wang, H.-C.; Tung, H.-L.; Liu, H.-C.; Shan, Y.-S. The Differential Clinical Impacts of Cachexia and Sarcopenia on the Prognosis of Advanced Pancreatic Cancer. Cancers 2022, 14, 3137. https://doi.org/10.3390/cancers14133137
Hou Y-C, Chen C-Y, Huang C-J, Wang C-J, Chao Y-J, Chiang N-J, Wang H-C, Tung H-L, Liu H-C, Shan Y-S. The Differential Clinical Impacts of Cachexia and Sarcopenia on the Prognosis of Advanced Pancreatic Cancer. Cancers. 2022; 14(13):3137. https://doi.org/10.3390/cancers14133137
Chicago/Turabian StyleHou, Ya-Chin, Chien-Yu Chen, Chien-Jui Huang, Chih-Jung Wang, Ying-Jui Chao, Nai-Jung Chiang, Hao-Chen Wang, Hui-Ling Tung, Hsiao-Chun Liu, and Yan-Shen Shan. 2022. "The Differential Clinical Impacts of Cachexia and Sarcopenia on the Prognosis of Advanced Pancreatic Cancer" Cancers 14, no. 13: 3137. https://doi.org/10.3390/cancers14133137