Skeletal Muscle Index Changes on Locoregional Treatment Application After FOLFIRINOX and Survival in Pancreatic Cancer
ABSTRACT Background Patients with borderline resectable (BR) or locally advanced pancreatic cancer (LAPC) require complex management strategies. This study evaluated the prognostic significance of the perichemotherapy skeletal muscle index (SMI) and carbohydrate antigen 19‐9 (CA 19‐9) in patients wi...
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| Language: | English |
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Wiley
2025-02-01
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| Series: | Journal of Cachexia, Sarcopenia and Muscle |
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| Online Access: | https://doi.org/10.1002/jcsm.13643 |
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| author | Ji Hye Min Jeong Il Yu Seong Hyun Kim Young Kon Kim Kangpyo Kim Hee Chul Park Joon Oh Park Jung Yong Hong Kyu Taek Lee Kwang Hyuck Lee Jong Kyun Lee Joo Kyung Park Jin Ho Choi Jin Seok Heo In Woong Han Hongbeom Kim Sang Hyun Shin So Jung Yoon Sook‐young Woo |
| author_facet | Ji Hye Min Jeong Il Yu Seong Hyun Kim Young Kon Kim Kangpyo Kim Hee Chul Park Joon Oh Park Jung Yong Hong Kyu Taek Lee Kwang Hyuck Lee Jong Kyun Lee Joo Kyung Park Jin Ho Choi Jin Seok Heo In Woong Han Hongbeom Kim Sang Hyun Shin So Jung Yoon Sook‐young Woo |
| author_sort | Ji Hye Min |
| collection | DOAJ |
| description | ABSTRACT Background Patients with borderline resectable (BR) or locally advanced pancreatic cancer (LAPC) require complex management strategies. This study evaluated the prognostic significance of the perichemotherapy skeletal muscle index (SMI) and carbohydrate antigen 19‐9 (CA 19‐9) in patients with BRPC or LAPC treated with FOLFIRINOX. Methods We retrospectively evaluated 227 patients with BR or LAPC who received at least four cycles of chemotherapy between 2015 and 2020. We analysed chemotherapy response, changes in SMI (ΔSMI, %) on computed tomography (CT) and CA19‐9 to determine their impact on progression‐free survival (PFS) and overall survival (OS). After the early application of loco‐regional treatments (LRT) within 3 months after completing four cycles of chemotherapy, the outcomes were compared between ΔSMI and CA19‐9 subgroups. Results Among 227 patients (median age, 60 years; 124 [54.6%] male) with 97 BR and 130 LAPC, 50.7% showed partial response (PR) to chemotherapy, 44.5% showed stable disease and 4.8% showed progressive disease (PD). Post‐chemotherapy CA19‐9 levels were normalized in 41.0% of patients. The high and low ΔSMI groups (based on the gender‐specific cut‐off of −8.6% for males and −2.9% for females) comprised 114 (50.2%) and 113 (49.8%) patients, respectively. The high ΔSMI group had poorer survival rates than the low ΔSMI group in both PFS (HR = 1.32, p = 0.05) and OS (HR = 1.74, p = 0.001). Multivariable analysis showed that ΔSMI (high vs. low; PFS, HR = 1.39, p = 0.03; OS, HR = 1.82, p < 0.001) and post‐chemotherapy response (PD vs. PR/SD; PFS, HR = 18.69, p < 0.001; OS, HR = 6.19, p < 0.001) were independently associated with both PFS and OS. Additionally, the post‐chemotherapy CA19‐9 (≥ 37 vs. < 37; HR = 1.48, p = 0.01) was an independent predictor for PFS. Early application of LRT after chemotherapy significantly improved PFS and OS in both ΔSMI groups (all p < 0.05). However, it was not beneficial in the group with high ΔSMI and post‐chemotherapy CA19‐9 ≥ 37 (PFS, p = 0.39 and OS, p = 0.33). Conclusions Progressive sarcopenic deterioration after four cycles of chemotherapy was associated with poor survival outcomes in patients with BR or LAPC after FOLFIRINOX. We also investigated the optimal clinical setting for the early application LRTs using the ΔSMI and post‐chemotherapy CA 19‐9. |
| format | Article |
| id | doaj-art-a1b2087901cd4f6eb0306db5b495792d |
| institution | DOAJ |
| issn | 2190-5991 2190-6009 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Cachexia, Sarcopenia and Muscle |
| spelling | doaj-art-a1b2087901cd4f6eb0306db5b495792d2025-08-20T02:53:13ZengWileyJournal of Cachexia, Sarcopenia and Muscle2190-59912190-60092025-02-01161n/an/a10.1002/jcsm.13643Skeletal Muscle Index Changes on Locoregional Treatment Application After FOLFIRINOX and Survival in Pancreatic CancerJi Hye Min0Jeong Il Yu1Seong Hyun Kim2Young Kon Kim3Kangpyo Kim4Hee Chul Park5Joon Oh Park6Jung Yong Hong7Kyu Taek Lee8Kwang Hyuck Lee9Jong Kyun Lee10Joo Kyung Park11Jin Ho Choi12Jin Seok Heo13In Woong Han14Hongbeom Kim15Sang Hyun Shin16So Jung Yoon17Sook‐young Woo18Department of Radiology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDepartment of Radiation Oncology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDepartment of Radiology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDepartment of Radiology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDepartment of Radiation Oncology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDepartment of Radiation Oncology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDivisions of Hematology‐Oncology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDivisions of Hematology‐Oncology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDivisions of Gastroenterology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDivisions of Gastroenterology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDivisions of Gastroenterology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDivisions of Gastroenterology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDivisions of Gastroenterology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDepartment of Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDepartment of Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDepartment of Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDepartment of Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaDepartment of Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South KoreaBiomedical Statistics Center, Research Institute for Future Medicine Samsung Medical Center Seoul South KoreaABSTRACT Background Patients with borderline resectable (BR) or locally advanced pancreatic cancer (LAPC) require complex management strategies. This study evaluated the prognostic significance of the perichemotherapy skeletal muscle index (SMI) and carbohydrate antigen 19‐9 (CA 19‐9) in patients with BRPC or LAPC treated with FOLFIRINOX. Methods We retrospectively evaluated 227 patients with BR or LAPC who received at least four cycles of chemotherapy between 2015 and 2020. We analysed chemotherapy response, changes in SMI (ΔSMI, %) on computed tomography (CT) and CA19‐9 to determine their impact on progression‐free survival (PFS) and overall survival (OS). After the early application of loco‐regional treatments (LRT) within 3 months after completing four cycles of chemotherapy, the outcomes were compared between ΔSMI and CA19‐9 subgroups. Results Among 227 patients (median age, 60 years; 124 [54.6%] male) with 97 BR and 130 LAPC, 50.7% showed partial response (PR) to chemotherapy, 44.5% showed stable disease and 4.8% showed progressive disease (PD). Post‐chemotherapy CA19‐9 levels were normalized in 41.0% of patients. The high and low ΔSMI groups (based on the gender‐specific cut‐off of −8.6% for males and −2.9% for females) comprised 114 (50.2%) and 113 (49.8%) patients, respectively. The high ΔSMI group had poorer survival rates than the low ΔSMI group in both PFS (HR = 1.32, p = 0.05) and OS (HR = 1.74, p = 0.001). Multivariable analysis showed that ΔSMI (high vs. low; PFS, HR = 1.39, p = 0.03; OS, HR = 1.82, p < 0.001) and post‐chemotherapy response (PD vs. PR/SD; PFS, HR = 18.69, p < 0.001; OS, HR = 6.19, p < 0.001) were independently associated with both PFS and OS. Additionally, the post‐chemotherapy CA19‐9 (≥ 37 vs. < 37; HR = 1.48, p = 0.01) was an independent predictor for PFS. Early application of LRT after chemotherapy significantly improved PFS and OS in both ΔSMI groups (all p < 0.05). However, it was not beneficial in the group with high ΔSMI and post‐chemotherapy CA19‐9 ≥ 37 (PFS, p = 0.39 and OS, p = 0.33). Conclusions Progressive sarcopenic deterioration after four cycles of chemotherapy was associated with poor survival outcomes in patients with BR or LAPC after FOLFIRINOX. We also investigated the optimal clinical setting for the early application LRTs using the ΔSMI and post‐chemotherapy CA 19‐9.https://doi.org/10.1002/jcsm.13643FOLFIRINOXlocoregional treatmentspancreatic ductal adenocarcinomasarcopeniaskeletal‐muscle‐index changes |
| spellingShingle | Ji Hye Min Jeong Il Yu Seong Hyun Kim Young Kon Kim Kangpyo Kim Hee Chul Park Joon Oh Park Jung Yong Hong Kyu Taek Lee Kwang Hyuck Lee Jong Kyun Lee Joo Kyung Park Jin Ho Choi Jin Seok Heo In Woong Han Hongbeom Kim Sang Hyun Shin So Jung Yoon Sook‐young Woo Skeletal Muscle Index Changes on Locoregional Treatment Application After FOLFIRINOX and Survival in Pancreatic Cancer Journal of Cachexia, Sarcopenia and Muscle FOLFIRINOX locoregional treatments pancreatic ductal adenocarcinoma sarcopenia skeletal‐muscle‐index changes |
| title | Skeletal Muscle Index Changes on Locoregional Treatment Application After FOLFIRINOX and Survival in Pancreatic Cancer |
| title_full | Skeletal Muscle Index Changes on Locoregional Treatment Application After FOLFIRINOX and Survival in Pancreatic Cancer |
| title_fullStr | Skeletal Muscle Index Changes on Locoregional Treatment Application After FOLFIRINOX and Survival in Pancreatic Cancer |
| title_full_unstemmed | Skeletal Muscle Index Changes on Locoregional Treatment Application After FOLFIRINOX and Survival in Pancreatic Cancer |
| title_short | Skeletal Muscle Index Changes on Locoregional Treatment Application After FOLFIRINOX and Survival in Pancreatic Cancer |
| title_sort | skeletal muscle index changes on locoregional treatment application after folfirinox and survival in pancreatic cancer |
| topic | FOLFIRINOX locoregional treatments pancreatic ductal adenocarcinoma sarcopenia skeletal‐muscle‐index changes |
| url | https://doi.org/10.1002/jcsm.13643 |
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