Sarcopenia in pancreatic cancer: Effect on patient outcomes

Table 2 Studies analyzing the effect of sarcopenia on neoadjuvant therapy outcomes of pancreatic cancer

Ref.	Country	No. of patients	Inclusion	Imaging modality	Level	Time	Definition and cutoff	Sarcopenia prevalence before NAT	Resectability	Survival	Additional meaningful findings or comments
Cooper et al[35], 2015	United States	89	RPC	CT	L3	Before and after NAT	LSMI, < 55.4 cm2/m2 (M), < 38.9 cm2/m2 (F)	55%	(-)	(-)	SKM loss during NAT was correlated with DFS
Cloyd et al[36], 2018	United States	127	RPC, BRPC, LAPC	CT	L3	Before and after NAT, 3 mo and 12 mo after surgery (PD)	LSMI, < 55.4 cm2/m2 (M), < 38.9 cm2/m2 (F)	63%	NE	(-)	SKM gain between the postoperative period and 1-yr follow-up was correlated with improved OS
Sandini et al[13], 2018	United States and Italy	193	BRPC, LAPC	CT	L3	Before and after NAT	LSMI, < 43 cm2/m2 (M) where BMI < 25 kg/m2, < 53 cm2/m2 (M) where BMI > 25 kg/m2, < 41 cm2/m2 (F)1	44%	(-)	NE	SKM gain during NAT is correlated with better resectability
Griffin et al[14], 2019	Ireland	78	BRPC	CT	L3	Before and after NAT	LSMI, < 43 cm2/m2 (M) where BMI < 25 kg/m2, < 53 cm2/m2 (M) where BMI > 25 kg/m2, < 41 cm2/m2 (F)1	50%	(-)	(-)	Low muscle attenuation before NAT and SKM loss during NAT was correlated with decreased OS
Takeda et al[15], 2021	Japan	62	RPC	CT	L3	Before NAT	LSMI, < 43 cm2/m2 (M) where BMI < 25 kg/m2, < 53 cm2/m2 (M) where BMI > 25 kg/m2, < 41 cm2/m2 (F)1	40%	(-)	NE	Sarcopenia before NAT did not correlate with antitumor response and toxicity of therapy
Jin et al[37], 2022	China	119	RPC	CT	L3	Before and after NAT	LSMI, < 41 cm2/m2 (M), < 38.5 cm2/m2 (F)	48%	NE	(+) OS, DFS	SKM and fat wasting during NAT was correlated with decreased OS and DFS

¹This cutoff value for sarcopenia was defined by Martin et al[12] reported in 2013. BMI: Body mass index; BRPC: Borderline resectable pancreatic cancer; CT: Computed tomography; DFS: Disease-free survival; F: Female; L3: Level of the lumbar 3 vertebral body; LAPC: Locally advanced pancreatic cancer; LSMI: Lumbar skeletal muscle index; M: Male; NAT: Neoadjuvant therapy; NE: Not evaluated; OS: Overall survival; PD: Pancreaticoduodenectomy; RPC: Resectable pancreatic cancer; SKM: Skeletal muscle.