{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T14:21:03Z","timestamp":1792765263671,"version":"4.5.0"},"reference-count":45,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,7,5]],"date-time":"2018-07-05T00:00:00Z","timestamp":1530748800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01DK096167"],"award-info":[{"award-number":["R01DK096167"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01GM092758"],"award-info":[{"award-number":["R01GM092758"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01CA194593"],"award-info":[{"award-number":["R01CA194593"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01CA122596"],"award-info":[{"award-number":["R01CA122596"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005979","name":"Lustgarten Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005979","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011749","name":"Melvin and Bren Simon Cancer Center, Indiana University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011749","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>By the traditional definition of unintended weight loss, cachexia develops in ~80% of patients with pancreatic ductal adenocarcinoma (PDAC). Here, we measure the longitudinal body composition changes in patients with advanced PDAC undergoing 5\u2010fluorouracil, leucovorin, irinotecan, and oxaliplatin therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective review of 53 patients with advanced PDAC on 5\u2010fluorouracil, leucovorin, irinotecan, and oxaliplatin as first line therapy at Indiana University Hospital from July 2010 to August 2015. Demographic, clinical, and survival data were collected. Body composition measurement by computed tomography (CT), trend, univariate, and multivariate analysis were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among all patients, three cachexia phenotypes were identified. The majority of patients, 64%, had Muscle and Fat Wasting (MFW), while 17% had Fat\u2010Only Wasting (FW) and 19% had No Wasting (NW). NW had significantly improved overall median survival (OMS) of 22.6\u00a0months vs. 13.0\u00a0months for FW and 12.2\u00a0months for MFW (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.02). FW (HR\u00a0=\u00a05.2; 95% confidence interval\u00a0=\u00a01.5\u201317.3) and MFW (HR\u00a0=\u00a01.8; 95% confidence interval\u00a0=\u00a01.1\u20132.9) were associated with an increased risk of mortality compared with NW. OMS and risk of mortality did not differ between FW and MFW. Progression of disease, sarcopenic obesity at diagnosis, and primary tail tumours were also associated with decreased OMS. On multivariate analysis, cachexia phenotype and chemotherapy response were independently associated with survival. Notably, CT\u2010based body composition analysis detected tissue loss of &gt;5% in 81% of patients, while the traditional definition of &gt;5% body weight loss identified 56.6%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Distinct cachexia phenotypes were observed in this homogeneous population of patients with equivalent stage, diagnosis, and first\u2010line treatment. This suggests cellular, molecular, or genetic heterogeneity of host or tumour. Survival among patients with FW was as poor as for MFW, indicating adipose tissue plays a crucial role in cachexia and PDAC mortality. Adipose tissue should be studied for its mechanistic contributions to cachexia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.12307","type":"journal-article","created":{"date-parts":[[2018,7,5]],"date-time":"2018-07-05T23:15:02Z","timestamp":1530832502000},"page":"673-684","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":149,"title":["Three cachexia phenotypes and the impact of fat\u2010only loss on survival in FOLFIRINOX therapy for pancreatic cancer"],"prefix":"10.1002","volume":"9","author":[{"given":"Joshua K.","family":"Kays","sequence":"first","affiliation":[{"name":"Department of Surgery Indiana University School of Medicine  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safi","family":"Shahda","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology Indiana University School of Medicine  Indianapolis IN USA"},{"name":"IUPUI Center for Cachexia Research Innovation, and Therapy  Indianapolis IN USA"},{"name":"Indiana University Simon Cancer Center  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Stanley","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology Indiana University School of Medicine  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa M.","family":"Bell","sequence":"additional","affiliation":[{"name":"Department of Surgery Indiana University School of Medicine  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bert H.","family":"O'Neill","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology Indiana University School of Medicine  Indianapolis IN USA"},{"name":"Indiana University Simon Cancer Center  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc D.","family":"Kohli","sequence":"additional","affiliation":[{"name":"Department of Radiology University of California San Francisco School of Medicine  San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion E.","family":"Couch","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Indiana University School of Medicine  Indianapolis IN USA"},{"name":"IUPUI Center for Cachexia Research Innovation, and Therapy  Indianapolis IN USA"},{"name":"Indiana University Simon Cancer Center  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonidas G.","family":"Koniaris","sequence":"additional","affiliation":[{"name":"Department of Surgery Indiana University School of Medicine  Indianapolis IN USA"},{"name":"IUPUI Center for Cachexia Research Innovation, and Therapy  Indianapolis IN USA"},{"name":"Indiana University Simon Cancer Center  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa A.","family":"Zimmers","sequence":"additional","affiliation":[{"name":"Department of Surgery Indiana University School of Medicine  Indianapolis IN USA"},{"name":"Department of Anatomy and Cell Biology Indiana University School of Medicine  Indianapolis IN USA"},{"name":"Department of Biochemistry and Molecular Biology Indiana University School of Medicine  Indianapolis IN USA"},{"name":"IUPUI Center for Cachexia Research Innovation, and Therapy  Indianapolis IN USA"},{"name":"Indiana University Simon Cancer Center  Indianapolis IN 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