Relationships among body mass index, longitudinal body composition alterations, and survival in patients with locally advanced pancreatic cancer receiving chemoradiation: A pilot study

Context: In pancreatic cancer, the presence of obesity or weight loss is associated with higher mortality. Objectives: To explore the relationships among body mass index, longitudinal body composition alterations, and clinical outcomes in pancreatic cancer patients. Methods: Records of 41 patients with inoperable locally advanced pancreatic cancer who participated in a prospective chemoradiation study were reviewed. Body composition was analyzed from two sets of computed tomography images obtained before and after radiation treatment (median interval 104 days). Results: Median age was 59 years and 56% of patients were female. Twenty-four (59%) patients were either overweight (22%) or obese (37%). Sarcopenia was present in 26 (63%) patients. At follow-up, weight loss was experienced by 33 (81%) patients. The median losses (%) before and after treatment were weight 5% (P < 0.001), skeletal muscle (SKM) 4% (P = 0.003), visceral adipose tissue (VAT) 13% (P < 0.001), and subcutaneous adipose tissue 11% (P = 0.002). SKM loss positively correlated with age (P = 0.03), baseline body mass index (P < 0.001), and VAT (P = 0.04) index. Obese patients experienced higher losses in weight (P = 0.009), SKM (P = 0.02), and VAT (P = 0.02). Median survival was 12 months. In univariate analysis, age, baseline obesity, sarcopenic obesity, and losses (%) in weight, SKM, and VAT were associated with worse survival. In multivariate analysis, only age (hazard ratio = 1.033, P = 0.04) and higher VAT loss (hazard ratio = 2.6 and P = 0.03) remained significant. Conclusion: Our preliminary findings suggest that obese patients experience higher losses in weight, SKM, and VAT, which may contribute to poorer survival in these patients.