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 using 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, 1.32; 95% confidence interval, 0.76-2.30), unless a higher threshold (>10%) was used (hazard ratio, 1.77; 95% confidence interval, 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.

FIGURE 1

Study participant flowchart. FNA indicates fine needle aspiration.

FIGURE 2

Univariate comparisons of the median survival from PDAC diagnosis in all study subjects based on: weight loss above and below 5% weight loss at diagnosis (A) and weight loss above and below the median relative weight loss (8.4%) (B). Survival comparisons were performed for the Kaplan-Meier plots using log-rank tests.

FIGURE 2

Univariate comparisons of the median survival from PDAC diagnosis in all study subjects based on: weight loss above and below 5% weight loss at diagnosis (A) and weight loss above and below the median relative weight loss (8.4%) (B). Survival comparisons were performed for the Kaplan-Meier plots using log-rank tests.