Impact of Sarcopenia During Induction Treatment in Patients with Unresectable Locally Advanced Pancreatic Cancer: A Scoring Model for indication of Conversion Surgery

Background Chemotherapeutic advances have increased opportunities for conversion surgery (CS) of unresectable locally advanced (UR-LA) pancreatic cancer (PC). However, the optimal indications for CS remain unclear. We aimed to identify predictive factors of prognosis in UR-LA PC, and evaluate indication for CS using these factors including sarcopenia. 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). Each of these factors was assigned a value of 1, resulting in a scoring system ranging from 0 to 3 points. There was a significant difference in OS between the patients who scored 0 points and those who scored 1 to 3 points (median OS: 30.3 months v.s. 17.3 months, P  = 0.013). CS was associated with better OS among patients who scored 0 (not reached v.s. 25.5 months, P  = 0.039). Conclusions Change in sarcopenia is a novel predictor of the prognosis of patients with UR-LA PC. Patients with favorable scores in our simple scoring model, which incorporates three prognostic factors identified by the current analysis, may achieve better survival after CS than that achieved induction therapy alone.