{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T04:42:26Z","timestamp":1783744946532,"version":"3.55.0"},"reference-count":31,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2019,5,23]],"date-time":"2019-05-23T00:00:00Z","timestamp":1558569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Surgical resection offers the best chance of survival in patients with pancreatic cancer, but those with locally advanced disease (LAPC) are usually not surgical candidates. This cohort often receives either neoadjuvant chemotherapy or chemoradiation (CRT), but unintended weight loss coupled with muscle wasting (sarcopenia) can often be observed. Here, we report on the predictive value of changes in weight and muscle mass in 147 consecutive patients with LAPC treated with neoadjuvant CRT. Methods: Clinicopathologic data were obtained via a retrospective chart review. The abdominal skeletal muscle area (SMA) at the third lumbar vertebral body was determined via computer tomographic (CT) scans as a surrogate for the muscle mass and skeletal muscle index (SMI) calculated. Uni- and multi-variable statistical tests were performed to assess for impact on survival. Results: Weight loss (14.5 vs. 20.3 months; p = 0.04) and loss of muscle mass (15.1 vs. 22.2 months; p = 0.007) were associated with poor outcomes. The highest survival was observed in patients who had neither cachectic weight loss nor sarcopenia (27 months), with improved survival seen in those who ultimately received a resection (23 vs. 10 months; p &lt; 0.001). Cox regression revealed that either continued weight loss or continued muscle wasting (SMA reduction) was predictive of poor outcomes, whereas a sarcopenic SMI was not. Conclusions: Loss of weight and lean muscle in patients with LAPC is prognostic when persistent. Therefore, both should be assessed longitudinally and considered before surgery.<\/jats:p>","DOI":"10.3390\/cancers11050709","type":"journal-article","created":{"date-parts":[[2019,5,24]],"date-time":"2019-05-24T02:22:00Z","timestamp":1558664520000},"page":"709","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation"],"prefix":"10.3390","volume":"11","author":[{"given":"Patrick","family":"Naumann","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany"},{"name":"Clinical Cooperation Unit Radiation Oncology, dkfz Heidelberg, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Eberlein","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Farnia","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Miami, 1475 NW 12th Avenue, Suite 1500, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thilo","family":"Hackert","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Debus","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany"},{"name":"Clinical Cooperation Unit Radiation Oncology, dkfz Heidelberg, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany"},{"name":"Deutsches Konsortium f\u00fcr Translationale Krebsforschung (DKTK), Core Center Heidelberg, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie E.","family":"Combs","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Technical University Munich (TUM), Ismaninger Stra\u00dfe 22, 81675 M\u00fcnchen, Germany"},{"name":"Institute of innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum M\u00fcnchen (HMGU), Ingolst\u00e4dter Landstra\u00dfe 1, 85764 Oberschlei\u00dfheim, Germany"},{"name":"Deutsches Konsortium f\u00fcr Translationale Krebsforschung (DKTK), Partner Site Munich, 81675 M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,5,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1093\/annonc\/mdy033","article-title":"European cancer mortality predictions for the year 2018 with focus on colorectal cancer","volume":"29","author":"Malvezzi","year":"2018","journal-title":"Ann. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21551","article-title":"Cancer statistics, 2019","volume":"69","author":"Siegel","year":"2019","journal-title":"CA Cancer J. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1007\/s12094-017-1688-0","article-title":"Surgery for pancreatic ductal adenocarcinoma","volume":"19","author":"Vera","year":"2017","journal-title":"Clin. Transl. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.yasu.2017.03.001","article-title":"Can neoadjuvant therapy in pancreatic cancer increase the pool of patients eligible for pancreaticoduodenectomy?","volume":"51","author":"Hackert","year":"2017","journal-title":"Adv. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1097\/SLA.0000000000001850","article-title":"Locally advanced pancreatic cancer: Neoadjuvant therapy with folfirinox results in resectability in 60% of the patients","volume":"264","author":"Hackert","year":"2016","journal-title":"Ann. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1038\/s41575-018-0005-x","article-title":"Therapeutic developments in pancreatic cancer: Current and future perspectives","volume":"15","author":"Neoptolemos","year":"2018","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/1748-717X-7-28","article-title":"Neoadjuvant chemoradiation with gemcitabine for locally advanced pancreatic cancer","volume":"7","author":"Habermehl","year":"2012","journal-title":"Radiat. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1007\/s00066-013-0393-3","article-title":"Outcome after neoadjuvant chemoradiation and correlation with nutritional status in patients with locally advanced pancreatic cancer","volume":"189","author":"Naumann","year":"2013","journal-title":"Strahlenther. Onkol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/S1470-2045(10)70218-7","article-title":"Definition and classification of cancer cachexia: An international consensus","volume":"12","author":"Fearon","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1200\/JCO.2014.56.1894","article-title":"Diagnostic criteria for the classification of cancer-associated weight loss","volume":"33","author":"Martin","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S1470-2045(08)70153-0","article-title":"Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: A population-based study","volume":"9","author":"Prado","year":"2008","journal-title":"Lancet Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1007\/s11605-012-1923-5","article-title":"Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma","volume":"16","author":"Peng","year":"2012","journal-title":"J. Gastrointest. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1016\/j.clnu.2016.10.014","article-title":"Preoperative sarcopenia determinants in pancreatic cancer patients","volume":"36","author":"Carrara","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ijsu.2017.01.075","article-title":"Clinical impact of sarcopenia on prognosis in pancreatic ductal adenocarcinoma: A retrospective cohort study","volume":"39","author":"Ninomiya","year":"2017","journal-title":"Int. J. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Choi, Y., Oh, D.Y., Kim, T.Y., Lee, K.H., Han, S.W., Im, S.A., Kim, T.Y., and Bang, Y.J. (2015). Skeletal muscle depletion predicts the prognosis of patients with advanced pancreatic cancer undergoing palliative chemotherapy, independent of body mass index. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0139749"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1007\/s11605-017-3618-4","article-title":"Anthropometric changes in patients with pancreatic cancer undergoing preoperative therapy and pancreatoduodenectomy","volume":"22","author":"Cloyd","year":"2018","journal-title":"J. Gastrointest. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2416","DOI":"10.1245\/s10434-014-4285-2","article-title":"Characterization of anthropometric changes that occur during neoadjuvant therapy for potentially resectable pancreatic cancer","volume":"22","author":"Cooper","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1016\/j.surg.2016.09.038","article-title":"A clinically applicable muscular index predicts long-term survival in resectable pancreatic cancer","volume":"161","author":"Delitto","year":"2017","journal-title":"Surgery"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1016\/j.clnu.2015.08.005","article-title":"The impact of sarcopenia and myosteatosis on outcomes of unresectable pancreatic cancer or distal cholangiocarcinoma","volume":"35","author":"Rollins","year":"2016","journal-title":"Clin. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1001\/jamasurg.2018.0979","article-title":"Association between changes in body composition and neoadjuvant treatment for pancreatic cancer","volume":"153","author":"Sandini","year":"2018","journal-title":"JAMA Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1097\/MPA.0000000000000898","article-title":"Predictors of pancreatic cancer-associated weight loss and nutritional interventions","volume":"46","author":"Nemer","year":"2017","journal-title":"Pancreas"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.clnu.2018.02.016","article-title":"Comparing western and eastern criteria for sarcopenia and their association with survival in patients with pancreatic cancer","volume":"38","author":"Wu","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1159\/000442873","article-title":"Nutrition in pancreatic cancer: A review","volume":"2","author":"Gartner","year":"2016","journal-title":"Gastrointest. Tumors"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.ijsu.2012.02.015","article-title":"Enteral vs total parenteral nutrition following major upper gastrointestinal surgery","volume":"10","author":"Wheble","year":"2012","journal-title":"Int. J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/S0140-6736(16)32409-6","article-title":"Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (espac-4): A multicentre, open-label, randomised, phase 3 trial","volume":"389","author":"Neoptolemos","year":"2017","journal-title":"Lancet"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1097\/SLA.0000000000002557","article-title":"The impact of positive resection margins on survival and recurrence following resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma","volume":"269","author":"Ghaneh","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2801","DOI":"10.1245\/s10434-014-3607-8","article-title":"Prognostic impact of ca 19-9 on outcome after neoadjuvant chemoradiation in patients with locally advanced pancreatic cancer","volume":"21","author":"Combs","year":"2014","journal-title":"Ann. Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"58","DOI":"10.3945\/ajcn.115.111203","article-title":"What is the best reference site for a single mri slice to assess whole-body skeletal muscle and adipose tissue volumes in healthy adults?","volume":"102","author":"Schweitzer","year":"2015","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.nut.2017.09.005","article-title":"A comparison of three methods to assess body composition","volume":"47","author":"Tewari","year":"2018","journal-title":"Nutrition"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.3945\/ajcn.113.060228","article-title":"Central tenet of cancer cachexia therapy: Do patients with advanced cancer have exploitable anabolic potential?","volume":"98","author":"Prado","year":"2013","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2920","DOI":"10.1158\/1078-0432.CCR-08-2242","article-title":"Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment","volume":"15","author":"Prado","year":"2009","journal-title":"Clin. Cancer Res."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/11\/5\/709\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:54:29Z","timestamp":1760187269000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/11\/5\/709"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,23]]},"references-count":31,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2019,5]]}},"alternative-id":["cancers11050709"],"URL":"https:\/\/doi.org\/10.3390\/cancers11050709","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5,23]]}}}