WEIGHT TRACKING AS A NOVEL MARKER OF PROGNOSIS AFTER RESECTION FOR PANCREATIC CANCER
Jonathan J. Hue*1, Sarah C. Markt2, Ravi Kumar Kyasaram1, John Shanahan1, Goutham Rao1, Jordan M. Winter1
1General Surgery, University Hospitals Cleveland Medical Center, Univeristy Heights, OH; 2Case Western Reserve University School of Medicine, Cleveland, OH
Introduction: Pancreatic resection offers the best chance of long-term survival for pancreatic ductal adenocarcinoma (PDAC). Weight loss has been described as a prognostic marker in cancer. However, to our knowledge, no study has ever looked at the impact of this finding after resection.
Methods: Patient records with any pancreatic neoplasm (n=596) were identified from the University Hospitals clinical data repository, of which 135 underwent a resection for PDAC. Percent postoperative weight loss, using raw patient weight data from electronic records, was categorized into tertiles: <10% weight loss; 10-20% weight loss; >20% weight loss. Weight gain after a nadir was categorized as: no weight gain; weight gain 0.1-5.6 kg; and weight gain >5.6 kg. Multivariable Cox proportional hazards regression models were conducted to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for an association between overall survival and postoperative weight changes. Models were adjusted for age and stage at diagnosis, sex, and race.
Results: Men and women were roughly equally represented (50.4% female) and the majority of patients were white (80.7%): median age at diagnosis was 66 years (range 38-88). Most patients presented with clinical stage II disease (77.8%). 73.3% underwent a Whipple procedure, 20.0% a distal pancreatectomy, and 6.7% a total pancreatectomy. In total, 29.6% of patients had neoadjuvant chemotherapy and 72.6% had adjuvant chemotherapy. At time of analysis, 65.4% of patients were confirmed deceased with a median time from surgery to death of 469 days (range 35-1985 days).
Postoperatively, the median maximum weight was 76 kg, the median minimum weight (nadir) was 63.8 kg, and the median weight loss after resection was 16.0% (within 6 months postoperatively, range 0-56.3%). In total, 24.4% of patients lost between 0-10% weight, 39.3% lost between 10-20%, and 36.3% lost greater than 20%. There was no association between postoperative weight loss and overall survival comparing the 10-20% (HR: 1.14, 95% CI: 0.60-2.16) or >20% groups (HR: 1.01, 95% CI: 0.54-1.92) with 0-10% weight loss. Following surgery, 39.3% of patients failed to achieve any weight gain. Of the 60.7% of patients who did gain weight after their nadir, median increase was 5.6 kg (range 0.2-32.1 kg). Compared with those who failed to regain weight, patients who gained 0.2-5.6 kg postoperatively had a 58% (HR: 0.42, 95% CI: 0.23-0.76) reduced risk of overall mortality, and those who gained >5.6 kg had a 72% (HR: 0.28, 95% CI: 0.15-0.51) reduced risk of overall mortality.
Conclusions: Resections for pancreatic cancer are often complicated by substantial postoperative weight loss without any impact on survival. However, patients who are unable to eventually regain weight fair significantly worse.
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