# Impact of Sarcopenia During Induction Treatment in Patients With Unresectable Locally Advanced Pancreatic Cancer

## TL;DR

The study finds that sarcopenia and other factors affect survival in patients with advanced pancreatic cancer, and conversion surgery helps only in selected cases.

## Contribution

Identifies three preoperative prognostic factors and shows conversion surgery benefits only patients without these risk factors.

## Key findings

- Tumor size at 6 months, lymph node metastasis at diagnosis, and sarcopenia are significant prognostic factors for survival.
- Conversion surgery improves survival only in patients without these three risk factors.
- Changes in psoas muscle mass index (PMI) are linked to prognosis in unresectable locally advanced pancreatic cancer.

## Abstract

Chemotherapeutic advances have increased opportunities for conversion surgery (CS) in unresectable locally advanced (UR‐LA) pancreatic cancer (PC). However, the optimal indications for CS remain unclear. Sarcopenia has been associated with poor outcomes in PC, except UR‐LA PC. Herein, we aimed to evaluate the impact of sarcopenia on the prognosis of patients with UR‐LA PC.

In this retrospective study, we reviewed consecutive patients with UR‐LA PC who had received chemo(radio)therapy as an initial treatment between 2015 and 2023. We examined relevant clinical variables and CT findings at initial diagnosis and at 6 months after starting treatment.

Ten of the 41 patients had undergone CS. Tumor size at 6 months, clinical lymph node metastasis at diagnosis, and changes in sarcopenia over 6 months were associated with overall survival (OS) (multivariate analysis: hazard ratio = 3.25, 2.79, and 3.51, respectively). In the entire cohort, patients without any of these three factors had significantly better OS than those with one or more (median OS: 30.3 months vs. 17.3 months, p = 0.013). CS was associated with better OS among patients without these factors (not reached vs. 25.5 months, p = 0.039), but not in those with one or more.

The impact of change in sarcopenia on prognosis was demonstrated in patients with UR‐LA PC. Although, given the limited number of cases, CS might provide a survival benefit in carefully selected patients without prognostic factors such as tumor size at 6 months, clinical lymph node metastasis at diagnosis, and the rate of change of the psoas muscle mass index (PMI).

This study identified three preoperative prognostic factors—tumor size at 6 months, lymph node metastasis at diagnosis, and decline in psoas muscle mass (sarcopenia)—in patients with unresectable locally advanced pancreatic cancer. Conversion surgery was associated with improved survival only in patients without these risk factors, highlighting the importance of patient selection.