The prognostic significance of preoperative nutritional status in resected pancreatic ductal adenocarcinoma (PDAC)

Abstract

Background: Nutritional derangements are common hallmarks of PDAC. Their early detection and management are usually overlooked in routine practice. The aim of this study was to explore the prognostic value of nutritional status in patients (pts) undergoing surgery for PDAC. Method(s): We prospectively studied 73 non-consecutive pts submitted to surgery for PDAC from November 2015 to January 2018 at General and Pancreatic Surgery Unit, Pancreas Institute, University Hospital of Verona. Nutritional Risk Screening (NRS) 2002 was used to evaluate the nutritional risk. Body composition was assessed using Bioelectrical Impedance Vector Analysis (BIVA) the day before the scheduled surgery. Clinical, pathological and nutritional data were correlated to disease-free/overall survival (DFS/OS) using a Cox and logistic regression model. Kaplan-Meier curves were compared with Log-Rank. Result(s): The median age was 65 years [range 37-81], 41 pts were male (56.2%) and 32 were female (43.8%). Median follow-up was 11 months [range 1-40]. The majority (80.8%) were at risk of malnutrition (NRS-2002>=3), despite median BMI was 23.9 kg/ m2. At multivariate analysis, stage (HR 4.30, 95% CI 1.03-17.92, p=0.045), NRS-2002 (HR 6.51, 95% CI 1.39-30.38, p=0.017), fat-free mass (FFM) (HR 1.08, 95% CI 1.02- 1.14, p=0.013) were significant independent predictors for OS. Particularly, pts with preoperative NRS-2002 3 (94% vs 75%, p=0.02). Twenty-four pts (32.9%) were treated with neoadjuvant therapy. NRS-2002 was significantly higher in this subset of pts (p=0.026), with a significant difference according to chemotherapy regimens (Folfirinox vs. Gemcitabine/Nab-paclitaxel) (p=0.035). In pts treated with adjuvant chemotherapy (n=33, 45.2%) FFM correlated with worse DSF and OS (p=0.039 and p=0.039, respectively). Conclusion(s): Our analysis suggests that preoperative malnutrition has a detrimental impact on OS in PDAC. Therefore, preoperative nutritional screening and, possibly, targeted nutritional intervention may improve outcomes in resectable PDAC pts, particularly in those who are candidate to neoadjuvant therapy.