Abstract：
BACKGROUND: Assessment of individual tumor biology and response to systemic therapy in pancreatic ductal adenocarcinoma (PDAC) remains a clinical challenge. The significance of anthropometric (body composition) changes during chemotherapy as a surrogate for tumor biology in the setting of localized PDAC is unknown.
METHODS: A retrospective, single-institution analysis of patients with PDAC who received neoadjuvant therapy (NAT) and pancreatectomy from 2017 to 2021 was performed. Radiologic anthropometric analysis used artificial intelligence-driven software to segment and compute total and sub-compartment muscle area, adipose tissue area, and attenuation values at the level of the L3 vertebra. Kaplan-Meier survival estimates, log-rank tests, and multivariable Cox regression models were used in survival analyses.
RESULTS: The inclusion criteria were met by 138 patients. Although decreases in muscle and adipose tissue areas during NAT were predominant, a subset of patients experienced an increase in these compartments. Increases in muscle greater than 5% (hazard ratio [HR], 0.352; 95% confidence interval [CI] 0.135-0.918; p = 0.033) and increases in adipose tissue greater than 15% (HR, 0.375; 95% CI 0.144-0.978; p = 0.045), were significantly associated with improved survival, whereas loss of visceral fat greater than 15% was detrimental (HR 1.853; CI 1.099-3.124; p = 0.021). No significant associations with single time-point anthropometrics were observed. Gains in total muscle and adipose mass were associated with improved pathologic response to systemic therapy and less advanced pathologic tumor stage.
CONCLUSIONS: Dynamic anthropometric analysis during NAT for PDAC is a stronger prognostic indicator than measurements taken at a single point in time. Repeated anthropometric analysis during preoperative chemotherapy may serve as a biomarker for individual tumor biology and response to therapy.
METHODS: A retrospective, single-institution analysis of patients with PDAC who received neoadjuvant therapy (NAT) and pancreatectomy from 2017 to 2021 was performed. Radiologic anthropometric analysis used artificial intelligence-driven software to segment and compute total and sub-compartment muscle area, adipose tissue area, and attenuation values at the level of the L3 vertebra. Kaplan-Meier survival estimates, log-rank tests, and multivariable Cox regression models were used in survival analyses.
RESULTS: The inclusion criteria were met by 138 patients. Although decreases in muscle and adipose tissue areas during NAT were predominant, a subset of patients experienced an increase in these compartments. Increases in muscle greater than 5% (hazard ratio [HR], 0.352; 95% confidence interval [CI] 0.135-0.918; p = 0.033) and increases in adipose tissue greater than 15% (HR, 0.375; 95% CI 0.144-0.978; p = 0.045), were significantly associated with improved survival, whereas loss of visceral fat greater than 15% was detrimental (HR 1.853; CI 1.099-3.124; p = 0.021). No significant associations with single time-point anthropometrics were observed. Gains in total muscle and adipose mass were associated with improved pathologic response to systemic therapy and less advanced pathologic tumor stage.
CONCLUSIONS: Dynamic anthropometric analysis during NAT for PDAC is a stronger prognostic indicator than measurements taken at a single point in time. Repeated anthropometric analysis during preoperative chemotherapy may serve as a biomarker for individual tumor biology and response to therapy.
摘要：
背景：评估胰腺导管腺癌（PDAC）的个体肿瘤生物学和对全身治疗的反应仍然是一个临床挑战。在局部PDAC的情况下，化学疗法期间人体测量（身体成分）变化作为肿瘤生物学的替代品的重要性尚不清楚。
方法：回顾性研究，对2017~2021年接受新辅助治疗(NAT)和胰腺切除术的PDAC患者进行单机构分析.放射学人体测量分析使用人工智能驱动的软件来分割和计算总和亚室肌肉面积，脂肪组织面积,和L3椎骨水平的衰减值。Kaplan-Meier生存估计,对数秩测试，和多变量Cox回归模型用于生存分析。
结果：138例患者符合纳入标准。尽管NAT期间肌肉和脂肪组织区域的减少占主导地位，一部分患者经历了这些隔室的增加。肌肉增加大于5%(危险比[HR]，0.352；95%置信区间[CI]0.135-0.918；p=0.033），脂肪组织增加大于15%（HR，0.375；95%CI0.144-0.978；p=0.045），与生存率的提高显着相关，而内脏脂肪减少超过15%是有害的(HR1.853;CI1.099-3.124;p=0.021)。未观察到与单个时间点人体测量学的显着关联。总肌肉和脂肪量的增加与全身治疗的病理反应改善和病理肿瘤分期较低相关。
结论：NAT期间PDAC的动态人体测量分析是比在单个时间点进行的测量更强的预后指标。术前化疗期间的重复人体测量分析可以作为个体肿瘤生物学和对治疗反应的生物标志物。
方法：回顾性研究，对2017~2021年接受新辅助治疗(NAT)和胰腺切除术的PDAC患者进行单机构分析.放射学人体测量分析使用人工智能驱动的软件来分割和计算总和亚室肌肉面积，脂肪组织面积,和L3椎骨水平的衰减值。Kaplan-Meier生存估计,对数秩测试，和多变量Cox回归模型用于生存分析。
结果：138例患者符合纳入标准。尽管NAT期间肌肉和脂肪组织区域的减少占主导地位，一部分患者经历了这些隔室的增加。肌肉增加大于5%(危险比[HR]，0.352；95%置信区间[CI]0.135-0.918；p=0.033），脂肪组织增加大于15%（HR，0.375；95%CI0.144-0.978；p=0.045），与生存率的提高显着相关，而内脏脂肪减少超过15%是有害的(HR1.853;CI1.099-3.124;p=0.021)。未观察到与单个时间点人体测量学的显着关联。总肌肉和脂肪量的增加与全身治疗的病理反应改善和病理肿瘤分期较低相关。
结论：NAT期间PDAC的动态人体测量分析是比在单个时间点进行的测量更强的预后指标。术前化疗期间的重复人体测量分析可以作为个体肿瘤生物学和对治疗反应的生物标志物。
