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Accelerated muscle and adipose tissue loss may predict survival in pancreatic cancer patients: the relationship with diabetes and anaemia

  • Katie M. Di Sebastiano (a1), Lin Yang (a2), Kevin Zbuk (a2), Raimond K. Wong (a2), Tom Chow (a2), David Koff (a3), Gerald R. Moran (a4) and Marina Mourtzakis (a1)...
Abstract

Weight loss leading to cachexia is associated with poor treatment response and reduced survival in pancreatic cancer patients. We aim to identify indicators that allow for early detection that will advance our understanding of cachexia and will support targeted anti-cachexia therapies. A total of fifty pancreatic cancer patients were analysed for skeletal muscle and visceral adipose tissue (VAT) changes using computed tomography (CT) scans. These changes were related to physical characteristics, secondary disease states and treatment parameters. Overall, patients lost 1·72 (sd 3·29) kg of muscle and 1·04 (sd 1·08) kg of VAT during the disease trajectory (413 (sd 213) d). After sorting patients into tertiles by rate of VAT and muscle loss, patients losing VAT at > − 0·40 kg/100 d had poorer survival outcomes compared with patients with < − 0·10 kg/100 d of VAT loss (P= 0·020). Patients presenting with diabetes at diagnosis demonstrated significantly more and accelerated VAT loss compared with non-diabetic patients. In contrast, patients who were anaemic at the first CT scan lost significantly more muscle tissue and at accelerated rates compared with non-anaemic patients. Accelerated rates of VAT loss are associated with reduced survival. Identifying associated features of cachexia, such as diabetes and anaemia, is essential for the early detection of cachexia and may facilitate the attenuation of complications associated with cachexia.

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Corresponding author
*Corresponding author: Dr M. Mourtzakis, fax +1 519 885 0470, email mmourtza@uwaterloo.ca
References
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1Vigano, M, Bruera, E, Jhangri, GS, et al. (2000) Clinical survival predictors in patients with advanced cancer. Arch Intern Med 160, 861868.
2Bachmann, J, Heiligensetzer, M, Krakowski-Roosen, H, et al. (2008) Cachexia worsens prognosis in patients with resectable pancreatic cancer. J Gastrointest Surg 12, 11931201.
3Fearon, K, Strasser, F, Anker, SD, et al. (2011) Definition and classification of cancer cachexia: and international consensus. Lancet Oncol 12, 489495.
4Wigmore, SJ, Plester, CE, Richardson, RA, et al. (1997) Changes in nutritional status associated with unresectable pancreatic cancer. Br J Cancer 75, 106109.
5Wang, X, Hu, Z, Hu, J, et al. (2006) Insulin resistance accelerates muscle protein degradation: activation of the ubiquitin–proteasome pathway by defects in muscle cell signaling. Endocrinology 147, 41604168.
6Evans, WJ, Morely, JE, Argiles, J, et al. (2008) Cachexia: a new definition. Clin Nutr 27, 793799.
7Liedman, B, Andersson, H, Bosaeus, I, et al. (1997) Changes in body composition after gastrectomy: results of a controlled, prospective clinical trial. World J Surg 21, 416421.
8Tan, BHL, Birdsell, LA, Martin, L, et al. (2009) Sarcopenia in overweight or obese patients is an adverse prognostic factor in pancreatic cancer. Clin Cancer Res 15, 69736973.
9Despres, JP & Lemieux, I (2006) Abdominal obesity and metabolic syndrome. Nature 444, 881887.
10Johansen, D, Stocks, T, Jonsson, H, et al. (2010) Metabolic factors and the risk of pancreatic cancer: a prospective analysis of almost 580,000 men and women in the metabolic syndrome and cancer project. Cancer Epidemiol Biomarkers Prev 19, 23072317.
11Balentine, CJ, Enriquez, J, Fisher, W, et al. (2010) Intra-abdominal fat predicts survival in pancreatic cancer. J Gastrointest Surg 14, 18321837.
12World Health Organization (2001) Iron Deficiency Anaemia: Assessment, Prevention, and Control. Geneva: World Health Organization. http://whqlibdoc.who.int/hq/2001/WHO_NHD_01.3.pdf (WHO/NHD/0.1.3).
13Shen, W, Punyanitya, M, Wang, Z, et al. (2004) Total body skeletal muscle and adipose tissue volumes; estimates form a single abdominal cross-sectional image. J Appl Physiol 97, 23332338.
14Shen, W, Punyanitya, M, Wang, Z, et al. (2004) Visceral adipose tissue relations between single-slice areas and total volume. Am J Clin Nutr 80, 271278.
15Mourtzakis, M, Prado, CMM, Lieffers, JR, et al. (2008) A practical and precise approach to quantifications of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 33, 9971006.
16Alberti, G, Zimmet, P, Shaw, J, et al. (2006) The IDF consensus worldwide definition of the metabolic syndrome. International Diabetes Federation. http://www.idf.org/webdata/docs/IDF_Meta_def_final.pdf.
17Mitsiopoulos, N, Baumgartner, RN, Heymsfield, SB, et al. (1998) Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol 85, 115122.
18Miller, KD, Jones, E, Yanovski, JA, et al. (1998) Visceral abdominal-fat accumulation associated with use of indinavir. Lancet 351, 871875.
19Snyder, WS, Cooke, MJ, Manssett, ES, et al. (1975) Report of the Task Group on Reference Man. Oxford: Pergamon.
20World Health Organization (2001) Obesity: Preventing and Managing the Global Epidemic. WHO Technical Report Series no. 894. Geneva: WHO.
21Frontera, WR, Hughes, VA, Fielding, RA, et al. (2000) Aging of skeletal muscle; a 12-year longitudinal study. J Appl Physiol 88, 13211326.
22Lexell, J, Taylor, CC & Sjostrom, M (1988) What is the cause of the aging atrophy? Total number, size, and proportion of different fibre types in whole vastus lateralis from 15- to 83-year-old men. J Neurol Sci 84, 275294.
23Lieffers, JR, Mourtzakis, M, Hall, KD, et al. (2009) A viscerally driven cachexia syndrome in patients with advanced colorectal cancer; contributions of organ and tumor mass to whole-body energy demands. Am J Clin Nutr 89, 11731179.
24Hallgreen, CE & Hall, KD (2008) Allometric relationship between changes of visceral fat and total mass. Int J Obes (Lond) 32, 845852.
25Bruckart, K, Beca, S, Urban, RJ, et al. (2010) Pathogenesis of muscle wasting in cancer cachexia: targeted anabolic and anti-catabolic therapies. Curr Opin Clin Nutr Metab Care 13, 410416.
26Glass, DJ (2010) Signaling pathways perturbing muscle mass. Curr Opin Clin Nutr Metab Care 13, 225229.
27Tayek, JA (1992) A review of cancer cachexia and abnormal glucose metabolism. J Am Coll Nutr 11, 445456.
28Park, SW, Goodpaster, BH, Lee, JS, et al. (2009) Health, aging, and body composition study. Excessive loss of skeletal muscle mass in older adults with type 2 diabetes. Diabetes Care 32, 19931997.
29Kim, TN, Park, MS, Yang, SJ, et al. (2010) Prevalence and determinant factors of sarcopenia in patients with type 2 diabetes: the Korean Sarcopenic Obesity Study (KSOS). Diabetes Care 33, 14971499.
30Kahl, J, Wykes, SM, Russell, ST, et al. (2005) Expression of the ubiquitin–proteasome pathway and muscle loss in experimental cancer cachexia. Br J Cancer 93, 774780.
31Weiss, G & Goodnough, LT (2005) Anemia of chronic disease. N Engl J Med 352, 10111023.
32Rasic-Milutinovic, Z, Perunicic-Pekovic, G, Ristic-Medic, D, et al. (2009) Insulin resistance and chronic inflammation are associated with muscle wasting in end-stage renal disease patients on hemodialysis. Gen Physiol Biophys 28, 184189(Spec No).
33Morley, JE (2009) Calories and cachexia. Curr Opin Clin Nutr Metab Care 12, 607610.
34Colomer, R, Moreno-Nogueira, JM, Garcia-Luna, PP, et al. (2007) n-3 Fatty acids, cancer and cachexia: a systematic review of the literature. Br J Nutr 97, 823831.
35Brown, TT, Zelnik, DL & Dobs, AS (2003) Fish oil supplementation in the treatment of cachexia in pancreatic cancer patients. Int J Gastrointest Cancer 34, 143150.
36Mantovani, G, Maccio, A, Madeddu, C, et al. (2010) Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist 15, 200211.
37Holly, EA, Chaliha, I, Bracci, PM, et al. (2004) Signs and symptoms of pancreatic cancer: a population-based case–control study in the San Francisco Bay area. Clin Gastroenterol Hepatol 2, 510517.
38Wasif, N, Ko, CY, Farrell, J, et al. (2010) Impact of tumor grade on prognosis in pancreatic cancer: should we include grade in AJCC staging? Ann Surg Oncol 17, 23122320.
39Kiyama, T, Mizutani, T, Okuda, T, et al. (2005) Postoperative changes in body composition after gastrectomy. J Gastrointest Surg 9, 313319.
40Awad, S, Tan, BH, Cui, H, et al. (2011) Marked changes in body composition following neoadjuvant chemotherapy for oesophagogastric cancer. Clin Nutr 31, 7477.
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British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
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