Published online Jun 28, 2026. doi: 10.3748/wjg.v32.i24.118757
Revised: February 17, 2026
Accepted: March 23, 2026
Published online: June 28, 2026
Processing time: 149 Days and 13.5 Hours
Pancreatic cancer (PC) has one of the poorest prognoses among malignant diseases worldwide. In chemotherapy for advanced PC, the anti-tumor effect and tolerability often vary among patients, and reliable biomarkers to predict these outcomes remain unclear. Sarcopenia is recognized as an important prognostic factor in various cancers, and three-dimensional (3D) skeletal muscle volumetric analysis has recently emerged as an objective method for evaluating muscle status. However, the clinical and prognostic implications of volumetric skeletal muscle assessment in older patients with advanced PC undergoing gemcitabine plus nab-paclitaxel therapy have not been fully clarified.
To clarify the usefulness of 3D muscle volumetric analysis in predicting tole
We retrospectively enrolled 150 older patients (aged ≥ 65 years) with unresectable PC, including those with locally advanced and/or metastatic disease, who re
Forty-six (30.7%) patients were diagnosed with sarcopenia; the median TTF was significantly shorter in sarcopenic patients (59 days vs 211 days; P < 0.001). OS and PFS were also significantly worse in sarcopenic patients (median OS: 175 days vs 562 days, P < 0.001; median PFS: 88 days vs 242 days, P < 0.001). Multivariate analysis identified sarcopenia as an independent prognostic factor for poor TTF, OS, and PFS (all P < 0.001). Severe adverse events (> grade 3) occurred more frequently in patients with sarcopenia than in those without (47.8% vs 26.9%; P = 0.015). Among 135 patients with sequential imaging, the non-sarcopenia-maintenance group (n = 72) showed significantly longer OS (median 615 days) than the sarcopenia-progression (n = 25; 205 days) and sarcopenia-maintenance groups (n = 35; 185 days; P < 0.001).
Sarcopenia defined by 3D psoas volume index and early muscle deterioration were strongly associated with poor tolerability and survival, indicating that volumetric assessment may predict outcomes in older patients with advanced PC.
Core Tip: Sarcopenia is increasingly recognized as a key determinant of survival outcomes in various cancers. In this study, a three-dimensional psoas volume index was used to evaluate skeletal muscle dynamics in relation to clinical outcomes in older patients with advanced pancreatic cancer undergoing gemcitabine plus nab-paclitaxel therapy. Baseline sarcopenia and early muscle deterioration were strongly associated with poor tolerability, shorter time to treatment failure, and markedly reduced survival. These findings highlight that volumetric skeletal muscle assessment before and during chemotherapy may help predict clinical outcomes and contribute to more individualized treatment optimization in older patients with pancreatic cancer.