评估胰腺导管腺癌（PDAC）的个体肿瘤生物学和全身治疗的反应仍然是一个临床挑战。在局部 PDAC 的情况下，化疗期间人体测量（身体成分）变化作为肿瘤生物学替代指标的意义尚不清楚。对 2017 年至 2021 年接受新辅助治疗 (NAT) 和胰腺切除术的 PDAC 患者进行回顾性单机构分析被执行。放射人体测量分析使用人工智能驱动的软件来分割和计算总肌肉区和次区室肌肉面积、脂肪组织面积以及 L3 椎骨水平的衰减值。 Kaplan-Meier 生存估计、时序检验和多变量 Cox 回归模型用于生存分析。138 名患者符合纳入标准。尽管 NAT 期间肌肉和脂肪组织面积的减少占主导地位，但一部分患者的这些区室面积有所增加。肌肉增加超过 5%（风险比 [HR]，0.352；95% 置信区间 [CI] 0.135-0.918；p = 0.033），脂肪组织增加超过 15%（HR，0.375；95% CI 0.144- 0.978；p = 0.045）与生存改善显着相关，而内脏脂肪减少超过 15% 则是有害的（HR 1.853；CI 1.099-3.124；p = 0.021）。没有观察到与单一时间点人体测量学的显着关联。总肌肉和脂肪量的增加与全身治疗病理反应的改善和较晚期的病理肿瘤阶段相关。在 PDAC NAT 期间进行动态人体测量分析是比单个时间点进行的测量更强的预后指标。术前化疗期间重复的人体测量分析可以作为个体肿瘤生物学和治疗反应的生物标志物。© 2024。外科肿瘤学会。

Assessment of individual tumor biology and response to systemic therapy in pancreatic ductal adenocarcinoma (PDAC) remains a clinical challenge. The significance of anthropometric (body composition) changes during chemotherapy as a surrogate for tumor biology in the setting of localized PDAC is unknown.A retrospective, single-institution analysis of patients with PDAC who received neoadjuvant therapy (NAT) and pancreatectomy from 2017 to 2021 was performed. Radiologic anthropometric analysis used artificial intelligence-driven software to segment and compute total and sub-compartment muscle area, adipose tissue area, and attenuation values at the level of the L3 vertebra. Kaplan-Meier survival estimates, log-rank tests, and multivariable Cox regression models were used in survival analyses.The inclusion criteria were met by 138 patients. Although decreases in muscle and adipose tissue areas during NAT were predominant, a subset of patients experienced an increase in these compartments. Increases in muscle greater than 5% (hazard ratio [HR], 0.352; 95% confidence interval [CI] 0.135-0.918; p = 0.033) and increases in adipose tissue greater than 15% (HR, 0.375; 95% CI 0.144-0.978; p = 0.045), were significantly associated with improved survival, whereas loss of visceral fat greater than 15% was detrimental (HR 1.853; CI 1.099-3.124; p = 0.021). No significant associations with single time-point anthropometrics were observed. Gains in total muscle and adipose mass were associated with improved pathologic response to systemic therapy and less advanced pathologic tumor stage.Dynamic anthropometric analysis during NAT for PDAC is a stronger prognostic indicator than measurements taken at a single point in time. Repeated anthropometric analysis during preoperative chemotherapy may serve as a biomarker for individual tumor biology and response to therapy.© 2024. Society of Surgical Oncology.