Three-dimensional psoas muscle volume and longitudinal changes as predictors of outcomes in older patients with advanced pancreatic cancer

Table 1 Baseline characteristics of enrolled patients, median (range)/n (%)

Characteristics	All patients	Sarcopenic patients	Non-sarcopenic patients	P value
Patients	150	46 (30.7)	104 (69.3)
Age, years	72.1 (65-85)	73.1 (65-83)	71.5 (65-85)	0.429
Sex				1.000
Male	80 (53.3)	25 (54.3)	55 (52.9)
Female	70 (46.7)	21 (45.7)	49 (47.1)
Weight, kg	53.4 (34.4-94.3)	51.0 (38.3-64.7)	54.6 (34.4-94.3)	0.003
BMI, kg/m2	20.9 (14.2-35.5)	19.1 (14.2-23.8)	21.5 (15.9-35.5)	< 0.001
PMV, cm3				< 0.001
Male	344 (165-568)	255 (165-303)	376 (218-568)
Female	213 (114-371)	155 (114-192)	236 (146-371)
PVI, cm3/m3				< 0.001
Male	72.9 (31.9-138.7)	56.4 (31.9-60.3)	82.2 (62.1-138.7)
Female	57.6 (30.2-111.2)	40.1 (30.2-43.5)	63.4 (47.7-111.2)
ECOG PS				0.043
0	91 (60.7)	23 (50.0)	68 (65.4)
1	44 (29.3)	18 (39.1)	26 (25.0)
2	12 (8.0)	3 (6.5)	10 (9.6)
3	2 (1.3)	2 (4.3)	0 (0.0)
Tumor size, mm	31.0 (10-78)	35.5 (14-78)	31.0 (10-70)	0.140
Location of tumor				0.053
Head	71 (47.3)	16 (34.8)	55 (52.9)
Body or tail	79 (52.7)	30 (65.2)	49 (47.1)
Clinical stage				0.015
Locally advanced	53 (35.3)	11 (23.9)	42 (40.4)
Metastasis	90 (60.0)	35 (76.1)	55 (52.9)
Recurrence	7 (4.7)	0 (0.0)	7 (6.7)
Leukocyte, × 103/μL	5.8 (2.6-19.4)	5.8 (2.9-16.3)	5.8 (2.6-19.4)	0.592
Neutrophil, × 103/μL	3.7 (0.9-15.2)	3.9 (1.4-14.5)	3.6 (0.9-15.2)	0.122
Lymphocyte, × 103/μL	1.5 (0.3-3.6)	1.4 (0.3-3.6)	1.5 (0.7-2.9)	0.149
Platelet, × 104/μL	21.7 (9.4-71.5)	21.8 (9.4-71.5)	21.4 (11.1-41.9)	0.207
Albumin, g/dL	3.7 (2.5-5.0)	3.6 (2.5-4.5)	3.8 (2.7-5.0)	0.066
CRP, mg/dL	0.3 (0.0-14.2)	0.6 (0.0-12.2)	0.2 (0.0-14.2)	0.082
CA19-9, U/mL	459 (2-120000)	1018 (2-120000)	275 (2-120000)	0.040
Total cholesterol, mg/dL	172 (85-484)	174 (101-313)	170 (85-484)	0.463
Cholinesterase, IU/L	248 (105-620)	217 (112-586)	257 (105-620)	0.009
NLR				0.053
< 2.5	77 (51.3)	18 (39.1)	59 (56.7)
≥ 2.5	73 (48.7)	28 (60.9)	45 (43.3)
m-GPS				0.214
0	81 (54.0)	21 (45.7)	60 (57.7)
1-2	69 (46.0)	25 (54.3)	44 (42.3)
PNI				0.077
< 45	81 (54.0)	30 (65.2)	51 (49.0)
≥ 45	69 (46.0)	16 (34.8)	53 (51.0)

BMI: Body mass index; PMV: Psoas muscle volume; PVI: Psoas volume index; ECOG PS: Eastern Cooperative Oncology Group Performance Status; CRP: C-reactive protein; CA19-9: Carbohydrate antigen 19-9; NLR: Neutrophil-to-lymphocyte ratio; m-GPS: Modified Glasgow Prognostic Score; PNI: Prognostic nutritional index.

Table 2 Treatment efficacy and treatment course in the sarcopenic and non-sarcopenic patients, median (range)/n (%)

Variable	Sarcopenic patients	Non-sarcopenic patients	P value
Patients,	46 (30.7)	104 (69.3)
Completion rate of GnP
Until one cycle	65.2 (30/46)	99.0 (103/104)	< 0.001
Until two cycles	51.2 (22/43)	94.1 (96/102)	< 0.001
Treatment response (n = 143)
Objective response rate	9.1 (4/44)	19.2 (19/99)	0.147
Disease control rate	43.2 (19/44)	87.9 (87/99)	< 0.001
Relative dose intensity, %
Until the first one cycle
Gemcitabine	80.7 (50.5-101.3)	81.8 (41.5-103.7)	0.966
Nab-paclitaxel	80.6 (51.5-99.0)	81.4 (39.8-103.7)	0.934
Until the first two cycles (n = 126)
Gemcitabine	79.6 (63.4-96.8)	80.6 (47.1-102.4)	0.758
Nab-paclitaxel	79.7 (58.3-99.0)	79.8 (48.4-102.4)	0.712
Treatment after GnP (n = 96)			0.004
Second-line therapy after GnP	17 (45.9)	45 (76.3)
FOLFIRINOX	3 (8.1)	21 (35.6)
Nal-IRI plus 5-FU/LV	4 (10.8)	9 (15.3)
Gemcitabine monotherapy	3 (8.1)	3 (5.1)
TS-1 monotherapy	6 (16.2)	10 (16.9)
TS-1 plus radiotherapy	1 (2.7)	2 (3.4)
Best supportive care	20 (54.1)	14 (23.7)

GnP: Gemcitabine plus nab-paclitaxel; Nal-IRI: Nanoliposomal irinotecan; 5-FU/LV: 5-Fluorouracil/Leucovorin; TS-1: Titanium silicate zeolite.

Table 3 Univariate analyses of the clinical factors for time to treatment failure in enrolled patients

Variables	Univariate analysis
	HR	95%CI	P value
Age ≥ 75 years	1.41	0.95-2.10	0.083
Female sex	0.73	0.50-1.08	0.120
BMI < 22.0 kg/m2	0.78	0.52-1.19	0.257
ECOS PS ≥ 2	0.94	0.51-1.72	0.834
Tumor size ≥ 30 mm	1.40	0.92-2.13	0.112
Head in location of tumor	1.49	1.02-2.21	0.040
Metastasis in clinical stage	1.62	1.17-2.25	< 0.001
Leukocyte ≥ 6.0 × 103/μL	1.27	0.87-1.86	0.221
Neutrophil ≥ 4.0 × 103/μL	1.46	0.99-2.15	0.053
Lymphocyte ≥ 1.5 × 103/μL	0.87	0.59-1.28	0.482
Platelet ≥ 20.0 × 104/μL	1.13	0.77-1.67	0.535
Albumin < 3.5 g/dL	0.74	0.49-1.12	0.150
CRP ≥ 1 mg/dL	1.75	1.16-2.64	0.008
CA19-9 ≥ 600 U/mL	1.85	1.25-2.76	0.002
Total cholesterol < 150 mg/dL	0.75	0.50-1.14	0.174
Cholinesterase < 250 IU/L	0.60	0.41-0.89	0.011
NLR ≥ 2.5	1.59	1.08-2.34	0.018
m-GPS ≥ 1	1.80	1.21-2.66	0.003
PNI < 45	0.60	0.40-0.89	0.011
Sarcopenia	5.58	3.55-8.78	< 0.001

BMI: Body mass index; ECOG PS: Eastern Cooperative Oncology Group Performance Status; CRP: C-reactive protein; CA19-9: Carbohydrate antigen 19-9; NLR: Neutrophil-to-lymphocyte ratio; m-GPS: Modified Glasgow Prognostic Score; PNI: Prognostic nutritional index; HR: Hazard ratio; CI: Confidence interval.

Table 4 Multivariate analyses of the clinical factors for time to treatment failure in enrolled patients

Variables	Multivariate analysis
	HR	95%CI	P value
Head in location of tumor	1.22	0.82-1.82	0.333
Metastasis in clinical stage	1.63	1.02-2.60	0.039
CA19-9 ≥ 600 U/mL	1.35	0.87-2.08	0.176
m-GPS ≥ 1	1.27	0.83-1.94	0.265
Sarcopenia	4.75	2.96-7.62	< 0.001

CA19-9: Carbohydrate antigen 19-9; m-GPS: Modified Glasgow Prognostic Score.

Table 5 Adverse events of grade 3 or 4 in the sarcopenic and non-sarcopenic patients, n (%)

Variable	Sarcopenic patients (n = 46)	Non-sarcopenic patients (n = 104)	P value
Total adverse events	22 (47.8)	28 (26.9)	0.015
Hematologic toxicity	16 (34.8)	15 (14.4)	0.001
Neutropenia	15 (32.6)	15 (14.4)
Anemia	1 (2.2)	0 (0.0)
Thrombocytopenia	1 (2.2)	0 (0.0)
Non-hematologic toxicity	11 (23.9)	13 (12.5)	0.093
Nausea	0 (0.0)	1 (1.0)
Loss of appetite	2 (4.3)	1 (1.0)
Fatigue	3 (6.5)	0 (0.0)
Diarrhea	0 (0.0)	1 (1.0)
Skin rash	5 (10.9)	3 (2.9)
Peripheral neuropathy	2 (4.3)	8 (7.7)
Interstitial pneumonia	3 (6.5)	1 (1.0)