The impact of sarcopenia and decrease in skeletal muscle mass in patients with advanced pancreatic cancer during FOLFIRINOX therapy

Sarcopenia, defined as decrease in skeletal muscle mass (SMM) and strength, might be associated with reduced survival. We investigated the impact of sarcopenia and decrease in SMM in patients with advanced pancreatic cancer during FOLFIRINOX (FX). Consecutive 69 patients who received FX were evaluated. Skeletal muscle index (SMI) (cm2/m2) was used to evaluate SMM. The cut-off value of sarcopenia was defined as SMI<42 for males and <38 for females, based on the Asian Working Group for sarcopenia criteria.Sarcopenia was diagnosed in 33 (48%) subjects. Comparison of baseline characteristics of the 2 groups (sarcopenia group: non-sarcopenia group) showed a significant difference in sex, tumor size and BMI. There was no significant difference in the incidence of adverse events with grades 3-5 and progression free survival (PFS) of FX between the 2 groups (PFS; 8.1 and 8.8 months; p=0.88). On the multivariate analysis, progressive disease at the first follow-up CT (HR 3.87, 95% CI 1.53-9.67), decreased SMI≧7.9% in 2 months (HR 4.02, 95%CI 1.87-8.97) and CEA ≥4.6 (HR 2.52, 95% CI 1.10-6.11) were significant risk factors associated with poor overall survival (OS), but sarcopenia at diagnosis was not. OS in patients with decreased SMI of ≧7.9% and <7.9 % were 10.9 and 21.0 months (p <0.01), respectively. In conclusion, decrease in SMM within 2 months after the initiation of chemotherapy had significantly shorter OS, although sarcopenia at diagnosis did not affect OS. Therefore, it might be important to maintain SMM during chemotherapy for a better prognosis.

Keywords: FOLFIRINOX; pancreatic cancer; sarcopenia; skeletal muscle mass.