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. 2025 Jun;79(6):576-586.
doi: 10.1038/s41430-025-01566-5. Epub 2025 Feb 5.

Impact of low muscle mass and myosteatosis on treatment toxicity and survival outcomes in non-resectable pancreatic cancer patients treated with chemoradiotherapy

Marine Perrier #  1 , Marine Fontaine #  2 , Eric Bertin  3 , Claire Carlier  4   5 , Damien Botsen  4   5 , Manel Djelouah  6 , Eric François  7 , Philippe Guilbert  2 , Angélique Saint  7 , Florian Slimano  8 , Paolo Torielli  2 , Mathias Brugel  9 , Olivier Bouché  4
Affiliations

Impact of low muscle mass and myosteatosis on treatment toxicity and survival outcomes in non-resectable pancreatic cancer patients treated with chemoradiotherapy

Marine Perrier et al. Eur J Clin Nutr. 2025 Jun.

Abstract

Background: Low skeletal muscle mass and impaired muscle quality (myosteatosis) have been associated with poor outcomes in cancer patients. This study aimed to evaluate the impact of pre-therapeutic low muscle mass and myosteatosis on chemoradiotherapy (CRT)-induced toxicity and survival outcomes in patients with non-resectable pancreatic cancer (PC).

Methods: In this retrospective study, pre-therapeutic CT scans were used to measure muscle mass/density. Low muscle mass was defined as a skeletal muscle index <38.5 cm²/m² (women) and <52.4 cm²/m² (men), and myosteatosis as a mean psoas density <41 HU if BMI < 25 kg/m² or <33 HU if BMI > 25 kg/m². Adverse effects were collected per week (W) of treatment. Dose-limiting toxicity (DLT) was defined as any toxicity leading to dose reduction, treatment delays or permanent discontinuation.

Results: Among the 85 included patients, 75 (88.2%) and 18 (22.2%) had pre-therapeutic low muscle mass and myosteatosis, respectively. Only 12 patients (14.1%) experienced DLT. Patients with low muscle mass developed significantly more toxicities at W2 (p = 0.013) and W5 (p = 0.026), notably more nausea (p = 0.037) and anemia (p = 0.004). Low muscle mass was associated with poorer overall survival (HR 4.41 [1.50-12.94], p = 0.007) in multivariate Cox analysis, while myosteatosis was not associated with CRT toxicities, DLT and overall survival (p = 0.408).

Conclusion: Patients with low muscle mass experienced more toxicities and poorer outcomes during CRT for non-resectable PC.

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Conflict of interest statement

Competing interests: CC reports personal fees as a speaker from Brystol Myers Squibb, outside the submitted work. DB reports personal fees as a speaker and/or in an advisory role from Accord Healthcare, Amgen, Sanofi, Servier, and Pierre Fabre, outside the submitted work. FS reports personal fees as a speaker and/or in an advisory role from Astra Zeneca, outside the submitted work. OB reports personal fees as a speaker and/or in an advisory role from Merck KGaA, Apmomia Therapeutics, Bayer, MSD, Amgen, Servier, and Pierre Fabre, outside the submitted work. All other authors have no conflict of interest. Ethical approval: The database of this retrospective study was constituted in accordance with the reference methodology MR004 of the French National Commission on Informatics and Liberty (CNIL) and the Helsinki Declaration. According to current French regulations, no informed consent or additional ethical committee review was required for retrospective studies using data from medical records collected in daily practice by medical and nursing staff caring for the patient and without human involvement. Data were anonymized prior to statistical analysis. Based on the non-opposition principle, information on the purpose of the study and the type of data collected was given to each patient included in the study. Patients were free to decline to participate, but none refused. The present study was declared to the Health Data Hub under the number F20220624135714 and is available at https://www.health-data-hub.fr .

Figures

Fig. 1
Fig. 1. Weekly any-grade toxicities during chemoradiotherapy.
Data expressed as total number of patients affected by a toxicity per week of treatment.
Fig. 2
Fig. 2. Percentages of side effects (any grade) during CRT.
According to: A low muscle mass and B myosteatosis.
Fig. 3
Fig. 3. Overall survival.
A In the entire cohort, B according to low muscle mass and C myosteatosis.
Fig. 4
Fig. 4. Progression-free survival.
A In the entire cohort, B according to low muscle mass and C myosteatosis.
See this image and copyright information in PMC

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