Prognostic impact of early nutritional support in patients affected by locally advanced and metastatic pancreatic ductal adenocarcinoma undergoing chemotherapy

• Published in: European journal of clinical nutrition Vol. 72; no. 5; pp. 772 - 779
• Main Authors: Trestini, Ilaria, Carbognin, Luisa, Sperduti, Isabella, Bonaiuto, Clelia, Auriemma, Alessandra, Melisi, Davide, Salvatore, Lisa, Bria, Emilio, Tortora, Giampaolo
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.05.2018; Nature Publishing Group
• Subjects: 631/67/1504/1713; 692/308; Adenocarcinoma; Adult; Aged; Aged, 80 and over; Body Mass Index; Body size; Body weight gain; Body weight loss; Cancer patients; Carcinoma, Pancreatic Ductal - complications; Carcinoma, Pancreatic Ductal - therapy; Care and treatment; Chemotherapy; Clinical Nutrition; Counseling; Diagnosis; Diet; Early Diagnosis; Endpoint Determination; Energy intake; Epidemiology; Female; Follow-Up Studies; Food and nutrition; Health aspects; Humans; Internal Medicine; Male; Malnutrition; Malnutrition - diagnosis; Malnutrition - etiology; Malnutrition - therapy; Medical prognosis; Medicine; Medicine & Public Health; Metabolic Diseases; Metastases; Metastasis; Middle Aged; Multivariate analysis; Neoplasm Metastasis; Nutrition; Nutrition Assessment; Nutritional Status; Nutritional Support; Pancreas; Pancreatic cancer; Patients; Prevention; Prognosis; Proportional Hazards Models; Public Health; Retrospective Studies; Risk Factors; Surgery; Treatment Outcome; Weight Gain; Weight Loss
• ISSN: 0954-3007; 1476-5640; 1476-5640
• DOI: 10.1038/s41430-018-0155-5

Background/objectives The aim of this analysis was to determine the risk of malnutrition and the prognostic value of nutritional intervention in patients affected by pancreatic ductal adenocarcinoma (PDAC) undergoing chemotherapy. Subjects/methods Clinical–pathological and nutritional data were correlated with overall survival (OS) using a Cox model. Nutritional status was determined by Malnutrition Universal Screening Tool (MUST), body mass index, weight loss in the past 6 months, presence of nutrition-related symptoms, and current energy intake. Nutritional intervention included appropriate individual dietary counseling. Results Data from 109 patients were gathered (median age 63 years). The majority of patients (64.2%) presented a MUST value of ≥ 2, corresponding to a high risk of malnutrition. At multivariate analysis for OS in locally advanced and metastatic PDAC patients, the time between the diagnosis and the nutritional intervention (HR 2.22, p  = 0.017), the performance status (HR 1.38, p  = 0.075), the surgery of the primary (HR 5.89, p  = 0.005), and the response to the first line (HR 5.9, p  = 0.03) were independent significant predictors of outcome. Furthermore, a weight gain > 2% from the baseline weight was correlated with the time between the diagnosis and the nutritional intervention ( p  = 0.021): in patients receiving a nutritional support within 3 months from diagnosis, a 2% weight gain was associated with a 2-year OS benefit (50.3% vs. 33.0%, p  = 0.04). Conclusions This analysis suggests that the early nutritional support may contribute to influence the prognosis of patients affected by advanced PDAC undergoing chemotherapy.