Predictors of Pancreatic Cancer–Associated Weight Loss and Nutritional Interventions

Abstract

Objectives Pancreatic ductal adenocarcinoma (PDAC) is often accompanied by weight loss. We sought to characterize factors associated with weight loss and observed nutritional interventions, as well as define the effect of weight loss on survival. Methods Consecutive subjects diagnosed with PDAC (n = 123) were retrospectively evaluated. Univariate analysis was used to compare subjects with and without substantial (>5%) weight loss. Multivariate logistic regression was performed to identify factors associated with weight loss, and survival analyses were performed Kaplan-Meier curves and Cox survival models. Results Substantial weight loss at diagnosis was present in 71.5% of subjects, and was independently associated with higher baseline body mass index, longer symptom duration, and increased tumor size. Recommendations for nutrition consultation and pancreatic enzyme replacement therapy occurred in 27.6% and 36.9% of subjects, respectively. Weight loss (>5%) was not associated with worse survival on multivariate analysis (hazard ratio (HR) 1.32, 95% CI, 0.76–2.30), unless a higher threshold (>10%) was used (HR 1.77, 95% CI, 1.09–2.87). Conclusions Despite the high prevalence of weight loss at PDAC diagnosis, there are low observed rates of nutritional interventions. Weight loss based on current criteria for cancer cachexia is not associated with poor survival in PDAC.

Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation

“…In our series, weight loss of 5% or more that corresponds to tumor cachexia was observed in 49% during CRT and in 85% when patient-reported weight loss prior to treatment initiation was included. This is in line with other reports among patients with newly diagnosed disease or when receiving neoadjuvant treatment, where rates of 62 to 72%, respectively, were identified [17,21]. Similarly, the majority of patients in our cohort (68%) had sarcopenia, comparable to published ranges of 55–65% for mostly resectable pancreatic cancer [13,14,16,17,19].…”

Circulating monocyte chemoattractant protein‐1 (MCP‐1) is associated with cachexia in treatment‐naïve pancreatic cancer patients

“…Pancreatic cancer patients have among the highest rates of cachexia, with an estimated 80–90% of patients with end‐stage disease affected . Additionally, cachexia in pancreatic cancer patients is not only associated with end‐stage disease as in other cancers, as our own analysis demonstrated that over 70% of newly diagnosed pancreatic cancer patients meet cachexia criteria . Although nearly 70% of pancreas cancers are diagnosed after they have become unresectable, even pancreatic cancer patients undergoing resection have cachexia, and estimates indicate that 40% of pancreatic cancer patients considered candidates for resection already exhibit a 10% body weight loss .…”

MRI Assessment of Associations between Brown Adipose Tissue and Cachexia in Murine Pancreatic Ductal Adenocarcinoma

“…Pancreatic ductal adenocarcinoma (PDAC) is one of the most highly associated with wasting of peripheral tissues, metabolic syndrome that impairs quality of life, limits cancer therapy, leading to decreased survival rate [ 1 ]. It is reported that complex cancer-associated factors contribute to the metabolic dysfunction in PDAC patients, including circulative inflammation factors, anatomic factors (extrinsic compression from the tumor causing gastric outlet obstruction), and/or the adverse effects of chemotherapy [ 2 ]. Adipose wasting may also be caused by altered exocrine pancreatic function [ 3 ].…”

“…Adipose wasting may also be caused by altered exocrine pancreatic function [ 3 ]. Although many studies have tried to reverse the symptom of cancer-associated cachexia, a complete reversal of wasting by using nutrition support or anti-cytokine treatment has not been achieved [ 2 , 4 ].…”