Sarcopenia in pancreatic cancer: Effect on patient outcomes

Table 3 Studies analyzing the effect of sarcopenia on palliative chemotherapy outcomes of pancreatic cancer

Ref.	Country	No. of patients	Inclusion (%)	Imaging modality	Level	Time	Definition and cutoff	Sarcopenia prevalence before CTX	CTX regimen	CTX toxicity	PFS	OS	Additional meaningful findings or comments
Kays et al[11], 2018	United States	53	LAPC (49), MPC (51)	CT	L3	Before and during CTX (median 5.6 times)	LSMI, < 52.4 cm2/m2 (M), < 38.5 cm2/m2 (F)1	49%	1st line FOLFIRINOX	NE	NE	(-)	No muscle wasting during CTX improved OS
Basile et al[16], 2019	Italy	94	LAPC (50), MPC (50)	CT	L3	Before and after 12 wk of CTX	LSMI, < 43 cm2/m2 (M) where BMI < 25 kg/m2, < 53 cm2/m2 (M) where BMI > 25 kg/m2, < 41 cm2/m2 (F)2	73%	Various	NE	(-)	(-)	Loss of skeletal muscle mass (≥ 10%) was associated with worse OS and PFS
Kurita et al[38], 2019	Japan	82	LAPC (35), MPC (65)	CT	L3	Before CTX	LSMI, clinically relevant cut-off: < 45.3 cm2/m2 (M), < 37.1 cm2/m2 (F)	51%	1st line FOLFIRINOX	(-)	(+)	(+)	Sarcopenic obesity was associated with hematologic toxicity
Lee et al[39], 2019	South Korea	57	LAPC (5), MPC (95)	CT	L3	Before and after 8 wk of CTX	LSMI, median level: unknown	50%	2nd line FOLFIRINOX	NE	(+)	(+)	Baseline LSMI was an independent predictor of survival in multivariable analysis
Kim et al[17], 2021	South Korea	251	MPC (100)	CT	L3	Before and after 8 wk of CTX	LSMI, < 43 cm2/m2 (M) where BMI < 25 kg/m2, < 53 cm2/m2 (M) where BMI > 25 kg/m2, < 41 cm2/m2 (F)2	41%	1st line gemcitabine-based CTX	(+) Overall grade ≥ 3 toxicity	(-)	(-)	Sarcopenia was a prognostic factor for OS but not for PFS in multivariable analysis
Uemura et al[21], 2021	Japan	69	LAPC (29), MPC (71)	CT	L3	Before and after 8 wk of CTX	LSMI, < 42 cm2/m2 (M), < 38 cm2/m2 (F)3	48%	1st line FOLFIRINOX	(-)	(-)	(-)	Loss of skeletal muscle mass (≥ 7.9%) is associated with worse OS
Williet et al[40], 2021	France	79	MPC (100)	CT	L3	Before CTX	TPAI, clinically relevant cutoff: 5.73 cm2/m2 (M), 4.37 cm2/m2 (F)	38%	Various	(-)	(+)	(+)	Measuring TPAI was less time-consuming than measuring LSMI
Asama et al[22], 2022	Japan	124	LAPC (29), MPC (60), RePC (15)	CT	L3	Before CTX	LSMI, < 42 cm2/m2 (M), < 38 cm2/m2 (F)3	49%	1st line Gem-Nab	(-)	(-)	(-)	In elderly patients (> 70 yr), sarcopenia was associated with worse OS
Emori et al[23], 2022	Japan	176	LAPC (14), MPC (86)	CT	L3	Before CTX	LSMI, < 42 cm2/m2 (M), < 38 cm2/m2 (F)3	53%	1st line Gem-Nab	(+) Overall grade ≥ 3 toxicity	(+)	(+)	Propensity score matching analysis was performed

¹This cutoff value for sarcopenia was defined by Prado et al[8] (2008).

²This cutoff value for sarcopenia was defined by Martin et al[12] (2013).

³This cutoff value for sarcopenia was defined by the Asian Working Group for Sarcopenia (Chen et al[20]) reported in 2014.

BMI: Body mass index; CT: Computed tomography; CTX: Chemotherapy; F: Female; FOLFIRINOX: Folinic acid, fluorouracil, irinotecan hydrochloride, and oxaliplatin; Gem-Nab: Gemcitabine plus nab-paclitaxel; L3: Level of the lumbar 3 vertebral body; LAPC: Locally advanced pancreatic cancer; LSMI: Lumbar skeletal muscle index; M: Male; MPC: Metastatic pancreatic cancer; NE: Not evaluated; OS: Overall survival; PFS: Progression-free survival; RePC: Recurrent pancreatic cancer; TPAI: Total psoas area index.