E279: Does the resolution or development of sarcopenia following neoadjuvant therapy for pancreatic adenocarcinoma correlate with pathologic tumor response?

Neoadjuvant therapy (NAT) is increasingly utilized in the treatment of pancreatic cancer. This time period may also be used as an opportunity to correct sarcopenia in debilitated patients in preparation for surgery. We sought to study the association between the resolution and development of sarcopenia after NAT with tumor response.

Methods:

A retrospective review was performed on patients undergoing pancreatectomy for adenocarcinoma between 2011-2021. An automated algorithm analyzed CT for body composition scores at diagnosis (baseline), presurgery (postNAT), and postSurgery. Sarcopenia was defined by skeletal muscle area, index, mean attenuation, and gender.

Results:

107 patients were included: 55 NAT and 52 upfront surgery (SURG). No differences in baseline characteristics were noted. At baseline, 64 (60%) had sarcopenia (64% SURG vs 56% NAT, p=0.55). Of the 55 patients who received NAT, 13% without sarcopenia developed it postNAT and 18% with sarcopenia resolved postNAT. Compared to the SURG group, NAT was associated with resolution of sarcopenia postSurgery (52% NAT vs 21% SURG, p=0.018). NAT was not associated with developing sarcopenia postSurgery (29% NAT vs 42% SURG, p=0.52) (Table 1).

Of the 55 NAT patients, 25% had a complete/near complete tumor response (CR), 38% had partial response (PR), and 36% had no/poor response (NR) on final pathology report. Type of chemotherapy was not associated with treatment response; however, the number of cycles approached association with improved treatment response (8 CR vs 6 NR, p=0.08). There was no significant difference in rates of NR between those who developed sarcopenia and those who remained healthy (p=0.53) or between those who had resolution of sarcopenia and those who remained sarcopenic (p=0.79) postNAT. Similarly, in the postSurgery time period, there was no significant difference in rates of NR between those developed sarcopenia and those who remained healthy (p=0.73) or between those who had resolution of sarcopenia and those who remained sarcopenic (p=1.00) (Table 1).

Conclusions:

Patients who underwent NAT versus SURG had higher rates of resolution of sarcopenia. However, the resolution of sarcopenia did not correlate to pathologic tumor response.

Given that increasing cycles of NAT has previously been shown to be associated with improved treatment response, early interventions to correct sarcopenia may help patients complete a full course of NAT and indirectly aid in improved tumor response.