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A LONGITUDINAL ASSESSMENT OF ANTHROPOMETRIC CHANGES IN PATIENTS WITH PANCREATIC DUCTAL ADENOCARCINOMA UNDERGOING PREOPERATIVE THERAPY AND PANCREATODUODENECTOMY
Jordan M. Cloyd*, Laura R. Prakash, Graciela M. Nogueras-González, Maria Petzel, Nathan Parker, An Ngo-Huang, Keri Schadler, David Fogelman, Jason Denbo, Naveen Garg, Michael P. Kim, Jeffrey E. Lee, Ching-Wei Tzeng, Jason B. Fleming, Matthew Katz
Surgical Oncology, MD Anderson Cancer Center, Houston, TX
Introduction: The anthropometric and nutritional changes associated with preoperative therapy and pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) have not previously been evaluated. We sought to quantify and to determine the clinical significance of changes that occur over the course of therapy and the first postoperative year.
Methods: 127 consecutive patients with PDAC who received preoperative chemotherapy and/or chemoradiation followed by pancreatoduodenectomy (PD) at a single institution between 2009-2012 were longitudinally evaluated. Evolving changes in patients’ nutritional profiles and body composition were measured by comparing laboratory parameters and cross-sectional areas of their skeletal muscle (SKM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) on computed tomography images obtained upon presentation, prior to PD, and approximately 3 and 12 months after surgery. Body mass index (BMI) was calculated using baseline height and weights at each corresponding interval.
Results: Prior to therapy, patients’ mean baseline BMI was 26.5±4.7 Kg/m2 and 63.0% met established criteria for sarcopenia. Preoperative therapy (12 [9.4%] chemotherapy alone, 44 [34.6%] chemoradiation alone, 71 [55.9%] both) was administered for a mean of 5.4±2.3 months. Only minor changes in VAT and SAT occurred during preoperative therapy, and there was no significant change in SKM or BMI. In contrast, a significant and progressive decline in BMI and a depletion of both muscle and fat were observed following surgery and throughout the first postoperative year (Table). Median overall survival of all patients was 32.8 months. Anthropometric changes during preoperative therapy were not independently associated with survival, but SKM gain between the postoperative period and one year follow-up was associated with improved overall survival (OR 0.50, 95% CI 0.29-0.87).
Conclusion: In contrast to the minor changes that occur during preoperative therapy for PDAC, significant losses in key anthropometric and nutritional parameters tend to occur over the first year following PD. Ongoing SKM loss in the postoperative period may represent an early marker for worse outcomes. Therefore, heightened attention to physiologic metrics both prior to and following completion of therapy is warranted.
Longitudinal assessment of nutritional and anthropometric changes occurring during and up to 1 year following treatment of PDAC
| | Pre-Treatment
(n=126) | Pre-Operative
(n=124) | Post-Operative
(n=121) | One Year
(n=90) | | | | Months since pre-treatment: 5.1±2.5 | Months since surgery: 3.3±1.6 | Months since surgery: 11.9±2.1 | | | Absolute | Absolute | % Change* | Absolute | % Change* | Absolute | % Change* | | SKM, cm2/m2 | 46.6 (8.9) | 46.2 (8.3) | -0.5 (7.8) | 44.0 (7.7) | -5.1 (10.7) | 42.3 (8.0) | -8.5 (12.4) | | | | | | | | | | | VAT, cm2/m2 | 47.9 (32.2) | 40.7 (29.1) | -1.8 (62.6) | 26.4 (23.4) | -41.4 (41.7) | 22.9 (21.5) | -48.9 (46.3) | | | | | | | | | | | SAT, cm2/m2 | 67.5 (37.1) | 62.0 (36.8) | -4.8 (27.7) | 46.6 (30.9) | -28.1 (28.0) | 40.6 (30.4) | -34.3 (41.5) | | | | | | | | | | | BMI, Kg/m2 | 26.5 (4.7) | 26.2 (4.5) | -0.9 (6.9) | 24.1 (4.2) | -9.1 (7.6) | 23.5 (4.4) | -10.9 (10.2) |
Values are mean (SD); *Values compared to those prior to therapy; Bold p<0.001
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