Prognostic Utility of the Cachexia Index in Resectable and Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Chemotherapy.

Objectives

The cachexia index (CXI), integrating skeletal muscle mass, serum albumin, and the neutrophil-to-lymphocyte ratio, has been proposed as a marker of cancer-related cachexia. The objective of this study was to assess the prognostic significance of pre-treatment CXI in patients with resectable or borderline resectable pancreatic ductal adenocarcinoma (PDAC) undergoing neoadjuvant chemotherapy (NAC) followed by resection.

Methods

We retrospectively analyzed 75 patients with resectable or borderline resectable PDAC who underwent NAC followed by curative resection (2012-2023). CXI was calculated using total skeletal muscle area (S-CXI) and psoas muscle area (P-CXI). Patients were stratified into low and normal groups using sex-specific tertiles.

Results

Baseline and pathological characteristics were comparable between groups. Low S-CXI was significantly associated with shorter recurrence-free survival (P=0.02) and overall survival (P=0.013). Multivariate analysis demonstrated that low S-CXI remained independently associated with both recurrence (HR 1.81, P=0.045) and mortality (HR 2.16, P=0.033); lymph-node metastasis was also associated with mortality. P-CXI was not associated with outcomes.

Conclusions

Pre-treatment S-CXI showed potential prognostic value for survival in patients with PDAC undergoing NAC followed by resection. This simple index may help identify high-risk patients who could benefit from perioperative multidisciplinary interventions. Prospective validation is warranted.