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

Background: 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. Methods: 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. Results: 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. Conclusions: 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).