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. 2023 Apr;8(2):101200.
doi: 10.1016/j.esmoop.2023.101200. Epub 2023 Mar 28.

Clinical risk factors for ascites in metastatic pancreatic cancer

J M Berger  1 , A Alany  2 , R Puhr  2 , L Berchtold  2 , A Friedrich  2 , B Scheiner  3 , G W Prager  2 , A S Berghoff  1 , M Preusser  1 , E S Bergen  4
Affiliations

Clinical risk factors for ascites in metastatic pancreatic cancer

J M Berger et al. ESMO Open. 2023 Apr.

Abstract

Background: Malignant ascites is common in metastatic pancreatic cancer (mPC) and its management still remains a clinical challenge. Early identification of patients at risk for ascites development may support and guide treatment decisions.

Materials and methods: Data of patients treated for mPC at the Medical University of Vienna between 2010 and 2019 were collected by retrospective chart review. Ascites was defined as clinically relevant accumulation of intraperitoneal fluid diagnosed by ultrasound or computer tomography scan of the abdomen. We investigated the association between general risk factors, metastatic sites, liver function, systemic inflammation as well as portal vein obstruction (PVO) and ascites development.

Results: Among 581 patients with mPC included in this study, 122 (21.0%) developed ascites after a median of 8.7 months after diagnosis of metastatic disease. The occurrence of ascites led to an 8.9-fold increased risk of death [confidence interval (CI) 7.2-11, P < 0.001] with a median overall survival of 1 month thereafter. Clinical risk factors for ascites were male sex [hazard ratio (HR) 1.71, CI 1.00-2.90, P = 0.048], peritoneal carcinomatosis (HR 6.79, CI 4.09-11.3, P < 0.001), liver metastases (HR 2.16, CI 1.19-3.91, P = 0.011), an albumin-bilirubin (ALBI) score grade 3 (HR 6.79, CI 2.11-21.8, P = 0.001), PVO (HR 2.28, CI 1.15-4.52, P = 0.019), and an elevated C-reactive protein (CRP) (HR 4.19, CI 1.58-11.1, P = 0.004).

Conclusions: Survival after diagnosis of ascites is very limited in mPC patients. Male sex, liver and peritoneal metastases, impaired liver function, PVO, as well as systemic inflammation were identified as independent risk factors for ascites development in this uniquely large real-life patient cohort.

Keywords: ascites; liver metastases; metastatic pancreatic cancer; peritoneal carcinomatosis; systemic inflammation.

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Conflict of interest statement

Disclosure BS received travel support from AbbVie, Ipsen, and Gilead. GWP advisory board meetings/symposiums: Merck Serono, Roche, Amgen, Sanofi, Lilly, Servier, Bayer, BMS, Celgene, CECOG, AstraZeneca, Pierre-Fabre, MSD, Daiichy Sankyo. ASB has research support from Daiichi Sankyo (≤€10 000), Roche (>€10 000) and honoraria for lectures, consultation, or advisory board participation from Roche, Bristol-Meyers Squibb, Merck, Daiichi Sankyo (all <€5000) as well as travel support from Roche, Amgen, and AbbVie. MP has received honoraria for lectures, consultation, or advisory board participation from the following for-profit companies: Bayer, Bristol-Myers Squibb, Novartis, Gerson Lehrman Group (GLG), CMC Contrast, GlaxoSmithKline, Mundipharma, Roche, BMJ Journals, MedMedia, Astra Zeneca, AbbVie, Lilly, Medahead, Daiichi Sankyo, Sanofi, Merck Sharp & Dome, Tocagen. ESB has honoraria for lectures, consultation, or advisory board participation from Servier. All other authors have declared no conflicts of interest. Data sharing Data of this study are available from the corresponding author upon reasonable request.

Figures

Figure 1
Figure 1
Risk for ascites development at 1, 3, 6, and 9 months after diagnosis of mPC according to different metastatic sites [metastatic pancreatic cancer (mPC)]. The cumulative risk was calculated based on fixed parameters for female and male patients, using the mean for all continuous variables and the normal category for discrete values. For the female patients, age: 6.479, CRP: 3.7, PLR: 2211.48, LLR: 6.48, MLR: 0.55, NLR: 4.44, total protein: normal, albumin: normal, ALBI score: grade II, and portal vein structure: absent were used. For the male patients, age: 6.4, CRP: 3.78, PLR: 2211.42, LLR: 6.81, MLR: 0.64, NLR: 4.65, total protein: normal, albumin: normal, ALBI score: grade II, and portal vein structure: absent were used. ALBI score, albumin–bilirubin score; CPR, C-reactive protein; LLR, leukocyte–lymphocyte ratio; MLR, monocyte–lymphocyte ratio; NLR, neutrophil–lymphocyte ratio; PLR, platelet–lymphocyte ratio.
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