胰腺癌 (aPC) 用化疗期间的肌肉和脂肪消耗与不良结局有关。我们旨在量化化疗方案和肿瘤进展对肌肉和脂肪消耗的贡献，并评估每种组织损失的预后价值。在加拿大艾伯塔省2013年至2019年接受aPC治疗的所有患者（n = 504）中，测量了化疗开始前后约12±4周内（n = 210），通过计算机断层扫描 (CT) 定义的肌肉和脂肪组织指数变化 (∆SMI, ∆ATI, cm2/m2)。用多变量线性回归方法评估方案和肿瘤反应对组织变化的贡献。用多变量Cox比例风险模型评估生存影响。116 (27) 天内，组织变化差异较大 (∆SMI: -17.8至+7.3 cm2/m2，∆ATI: -106.1至+37.7 cm2/m2)。肿瘤进展对肌肉和脂肪损失的贡献 (-3.2 cm2/m2, p < 0.001; -12.4 cm2/m2, p = 0.001)。FOLFIRINOX与更大的肌肉损失相关 (-1.6 cm2/m2, p = 0.013)，GEM/NAB与更大的脂肪损失相关 (-11.2 cm2/m2, p = 0.002)。最大的肌肉和脂肪损失与生存减少独立相关 (肌肉: HR 1.72, p = 0.007; 脂肪: HR 1.73, p = 0.012; tertile 1 与 tertile 3)。肌肉和脂肪损失是化疗的不良反应，可能需要特定于方案的管理策略。

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.