Muscle and adipose wasting during chemotherapy for advanced pancreatic cancer (aPC) are associated with poor outcomes. We aimed to quantify the contributions of chemotherapy regimen and tumour progression to muscle and adipose wasting and evaluate the prognostic value of each tissue loss. Of all patients treated for aPC from 2013–2019 in Alberta, Canada (n= 504), computed-tomography (CT)-defined muscle and adipose tissue index changes (∆SMI, ∆ATI, cm2/m2) were measured for patients with CT images available both prior to and 12 ± 4 weeks after chemotherapy initiation (n= 210). Contributions of regimen and tumour response to tissue change were assessed with multivariable linear regression. Survival impacts were assessed with multivariable Cox’s proportional hazards models. Tissue changes varied widely (∆SMI: −17.8 to +7.3 cm2/m2, ∆ATI: −106.1 to +37.7 cm2/m2) over 116 (27) days. Tumour progression contributed to both muscle and adipose loss (−3.2 cm2/m2,p< 0.001; −12.4 cm2/m2,p= 0.001). FOLFIRINOX was associated with greater muscle loss (−1.6 cm2/m2,p= 0.013) and GEM/NAB with greater adipose loss (−11.2 cm2/m2,p= 0.002). The greatest muscle and adipose losses were independently associated with reduced survival (muscle: HR 1.72,p= 0.007; adipose: HR 1.73,p= 0.012; tertile 1 versus tertile 3). Muscle and adipose losses are adverse effects of chemotherapy and may require regimen-specific management strategies.
晚期胰腺癌化疗期间肌肉与脂肪组织的消耗与不良预后相关。本研究旨在量化化疗方案与肿瘤进展对肌肉及脂肪组织消耗的贡献度，并评估各类组织损失的预后价值。通过分析2013-2019年间加拿大阿尔伯塔省接受治疗的晚期胰腺癌患者（n=504），对化疗开始前及开始后12±4周均具备CT影像数据的患者（n=210）进行计算机断层扫描定义的肌肉与脂肪组织指数变化（∆SMI、∆ATI，单位：cm²/m²）测量。采用多变量线性回归评估化疗方案与肿瘤反应对组织变化的贡献，并通过多变量Cox比例风险模型分析生存影响。 在平均116（标准差27）天的观察期内，组织变化呈现显著差异（∆SMI：-17.8至+7.3 cm²/m²；∆ATI：-106.1至+37.7 cm²/m²）。肿瘤进展同时导致肌肉与脂肪组织损失（-3.2 cm²/m²，p<0.001；-12.4 cm²/m²，p=0.001）。FOLFIRINOX方案与更显著的肌肉损失相关（-1.6 cm²/m²，p=0.013），而GEM/NAB方案则与更显著的脂肪损失相关（-11.2 cm²/m²，p=0.002）。最大程度的肌肉与脂肪组织损失均独立与生存期缩短显著相关（肌肉：风险比1.72，p=0.007；脂肪：风险比1.73，p=0.012；三分位第一组与第三组比较）。肌肉与脂肪组织消耗是化疗的不良反应，可能需要针对特定化疗方案制定管理策略。
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