Is Computed-Tomography-Based Body Composition a Reliable Predictor of Chemotherapy-Related Toxicity in Pancreatic Cancer Patients?

SIMPLE SUMMARY: Malnutrition and changes in body composition, such as weight loss and sarcopenia, are frequent in pancreatic cancer patients and are associated with worse survival outcomes according to several studies; however, research has not univocally determined whether or not they are specifically associated with a higher likelihood of toxicity from chemotherapy. This study retrospectively evaluated chemotherapy-related toxicity in a cohort of patients with metastatic pancreatic cancer and explored its relationship with body composition parameters including radiological measurements performed with a specialized software on CT scan images. Statistical analysis failed to show a clear and clinically significant association between the evaluated parameters and chemotoxicity, suggesting that relevant confounding factors likely play a more significant role in determining prognosis. ABSTRACT: Background: Malnutrition, loss of weight and of skeletal muscle mass are frequent in pancreatic cancer patients, a majority of which will undergo chemotherapy over the course of their disease. Available data suggest a negative prognostic role of these changes in body composition on disease outcomes; however, it is unclear whether tolerance to chemotherapeutic treatment is similarly and/or negatively affected. We aimed to explore this association by retrospectively assessing changes in body composition and chemotherapy-related toxicity in a cohort of advanced pancreatic cancer patients. Methods: Body composition was evaluated through clinical parameters and through radiological assessment of muscle mass, skeletal muscle area, skeletal muscle index and skeletal muscle density; and an assessment of fat distribution by subcutaneous adipose tissue and visceral adipose tissue. We performed descriptive statistics, pre/post chemotherapy comparisons and uni- and multivariate analyses to assess the relation between changes in body composition and toxicity. Results: Toxicity risk increased with an increase of skeletal muscle index (OR: 1.03) and body mass index (OR: 1.07), whereas it decreased with an increase in skeletal muscle density (OR: 0.96). Multivariate analyses confirmed a reduction in the risk of toxicity only with an increase in skeletal muscle density (OR: 0.96). Conclusions: This study suggests that the retrospective analysis of changes in body composition is unlikely to be useful to predict toxicity to gemcitabine—nab-paclitaxel.