Body weight loss after surgery affects the continuity of adjuvant chemotherapy for pancreatic cancer

Abstract

Background Postoperative chemotherapy is beneficial for many pancreatic cancer patients. However, some patients require dose reduction or the discontinuation of adjuvant chemotherapy because of adverse treatment-related effects. In this study, we aimed to evaluate two main outcomes. First, we evaluated the clinicopathological factors affecting patient disease-free survival (DFS) and overall survival (OS) following upfront surgery. Second, we evaluated the factors that influence the continuity of adjuvant chemotherapy. Methods Fifty-four patients with resected pancreatic cancer were enrolled. First, we evaluated the clinicopathological factors affecting postoperative survival using the Kaplan-Meier method and Cox regression method. Next, factors affecting the continuity of adjuvant chemotherapy were analyzed using multiple logistic regression analysis. Results Univariate and multivariate analyses revealed that positive LN metastasis (HR (95% CI) 6.329 (2.381–16.95); p < 0.001) and relative dose intensity (RDI) < 80% for adjuvant chemotherapy (HR (95% CI) 5.154 (1.761–15.15); p = 0.003) were independent predictive factors for DFS. Regarding OS, extended dissection of the nerve plexus around the superior mesenteric artery (SMA) (HR (95% CI) 4.504 (1.721–11.76); p = 0.002), positive microscopic surgical margin (HR (95% CI) 5.565 (1.724–17.96); p = 0.004), and adjuvant chemotherapy of RDI < 80% (HR (95% CI) 3.534 (1.135–2.667); p = 0.029) were also independent predictive factors. Moreover, the level of RDI significantly correlated with DFS and OS. Multiple logistic regression analysis revealed that low RDI was significantly associated with postoperative body weight loss (BWL) ≥ 10%. Conclusions The following factors were significantly associated with poor survival: extended dissection of the nerve plexus around the SMA, lymph node metastasis, residual tumor, and RDI of the adjuvant chemotherapy. Patient’s prognosis with adjuvant chemotherapy of RDI < 80% was worse. BWL ≥10% was the most important factor affecting the continuity of adjuvant chemotherapy. Perioperative nutritional intervention is necessary for patients who receive adjuvant chemotherapy for advanced pancreatic cancer.

Prognostic significance of surgery‐induced sarcopenia in the survival of gastric cancer patients: a sex‐specific analysis

“… 13 Hence, both preoperative and postoperative muscle mass should be considered when evaluating long‐term survival especially in GC patients undergoing gastrectomy. Indeed, few studies demonstrated that marked postoperative weight loss is a risk factor for poor prognosis in gastrointestinal and pancreatic cancers, 14 , 15 , 16 and excessive skeletal muscle loss after surgery is also a prognostic factor, 17 suggesting that surgery‐induced sarcopenia and postoperative muscle loss may be more harmful than preoperative sarcopenia in GC patients who undergo gastrectomy.…”

Classification Tree–Based Machine Learning to Visualize and Validate a Decision Tool for Identifying Malnutrition in Cancer Patients

“…[9][10][11] In fact, malnutrition is common among cancer patients, with an incidence rate ranging from 21% to 75%, as determined using different screening or assessment tools. [12][13][14] Malnutrition has a strong adverse impact on the tolerance of chemotherapy, 15 QOL, 16 complications, 17 and survival. 12 Thus, an early diagnosis and nutrition intervention are key components of strategies to improve the QOL and outcomes of patients, with interventions specifically targeting the reversible elements during the development of malnutrition.…”

A locally advanced pancreatic body cancer presenting common bile duct invasion resected via distal pancreatectomy after gemcitabine plus nab-paclitaxel chemotherapy: A case report

“…A merit would be preserving the relative dose intensity of adjuvant chemotherapy by maintaining nutrition and immune function by preserving bowel function. Some studies have reported that nutritional status, represented by serum albumin levels, and body weight and lean body mass is considered to affect adherence of patients with PC to postoperative chemotherapy and the reduced relative dose intensity of adjuvant chemotherapy has a negative impact on postoperative survival [19] , [20] , [21] , [22] . Meanwhile, as a demerit, such conservative procedure always carries the risk of incomplete resection.…”