Analysis of Computer Tomographic Image: Skeleto-muscle Index as a Criterion of Sarcopenia in Patients with Patients with Patients

Aim of the study. The study of the possibility and informativeness of the detection of sarcopenia in a patient with pancreatic cancer (PC) by post-processing obtained using computed tomography (CT) images.Materials and methods. A total of 108 patients with obstructive jaundice syndrome (probably of tumor etiology, and later diagnosed with pancreas cancer) were studied using the «Activion 16» spiral tomograph (Toshiba Medical Systems Corporation) according to a common protocol. The control group consisted of 60 patients aged from 22 to 74 years. We determined sarcopenia criteria on CT images: musculoskeletal L3 index (MSI) as the ratio of the area indicator of skeletal muscle in the body to the level L3 square growth patient. The somatotype index (SI) was determined by the formula: SI = BL x 100 / TSCH, where BL is the body length, TSCH is the transverse size of the chest, measurement in centimeters.Results. Based on media values at the L3 level, sarcopenia was generally detected in 85.18 % of patients with pancreas cancer. Sarcopenia was observed in 100 % of patients with a dolichomorphic type, in 87.8 % of patients with a mesomorphic type, and in 65.5 % of patients with a brachiomorphic type of somatotype. Sarcopenia based on SMI at the L3 level is set in 85.2 % of patients with pancreas cancer: 47.8±4.3 cm² / m² for men, 36.2±4.1 cm² / m² for women, 58.4±3 6 cm² / m² and 44.2±3.5 cm² / m² for conditionally healthy men and women, respectively (p<0.01). The reliable differences of SMI according to gender were established in conditionally healthy men and women suffering from pancreatic cancer with inaccurate differences in BMI. In patients, the statistically significant difference of SMI (p = 0.001), corresponds to the various distribution of fatty mass in the body structure, was accompanied by statistical misleading differences in BMI.Findings. CT as a standard method of diagnosis of pancreatic cancer and inflammatory diseases of the pancreas by calculating the SMI allows evaluating the degree of sarcopenia. SMI is more informative and personalized indicators to assess body composition than the standard used BMI as CT allows differentiation of muscle and fat components in the composition of the human body and to quantif

Perioperative Pembrolizumab for Early-Stage Non-Small-Cell Lung Cancer

BACKGROUND Among patients with resectable early-stage non-small-cell lung cancer (NSCLC), a perioperative approach that includes both neoadjuvant and adjuvant immune checkpoint inhibition may provide benefit beyond either approach alone.METHODS We conducted a randomized, double-blind, phase 3 trial to evaluate perioperative pembrolizumab in patients with early-stage NSCLC. Participants with resectable stage II, IIIA, or IIIB (N2 stage) NSCLC were assigned in a 1:1 ratio to receive neoadjuvant pembrolizumab (200 mg) or placebo once every 3 weeks, each of which was given with cisplatin-based chemotherapy for 4 cycles, followed by surgery and adjuvant pembrolizumab (200 mg) or placebo once every 3 weeks for up to 13 cycles. The dual primary end points were event-free survival (the time from randomization to the first occurrence of local progression that precluded the planned surgery, unresectable tumor, progression or recurrence, or death) and overall survival. Secondary end points included major pathological response, pathological complete response, and safety.RESULTS A total of 397 participants were assigned to the pembrolizumab group, and 400 to the placebo group. At the prespecified first interim analysis, the median follow-up was 25.2 months. Event-free survival at 24 months was 62.4% in the pembrolizumab group and 40.6% in the placebo group (hazard ratio for progression, recurrence, or death, 0.58; 95% confidence interval [CI], 0.46 to 0.72; P<0.001). The estimated 24-month overall survival was 80.9% in the pembrolizumab group and 77.6% in the placebo group (P = 0.02, which did not meet the significance criterion). A major pathological response occurred in 30.2% of the participants in the pembrolizumab group and in 11.0% of those in the placebo group (difference, 19.2 percentage points; 95% CI, 13.9 to 24.7; P<0.0001; threshold, P = 0.0001), and a pathological complete response occurred in 18.1% and 4.0%, respectively (difference, 14.2 percentage points; 95% CI, 10.1 to 18.7; P<0.0001; threshold, P = 0.0001). Across all treatment phases, 44.9% of the participants in the pembrolizumab group and 37.3% of those in the placebo group had treatment-related adverse events of grade 3 or higher, including 1.0% and 0.8%, respectively, who had grade 5 events.CONCLUSIONS Among patients with resectable, early-stage NSCLC, neoadjuvant pembrolizumab plus chemotherapy followed by resection and adjuvant pembrolizumab significantly improved event-free survival, major pathological response, and pathological complete response as compared with neoadjuvant chemotherapy alone followed by surgery. Overall survival did not differ significantly between the groups in this analysis