Is Weight Loss During Chemotherapy for Pancreatic Cancer Prognostic?

Davis, Mellar P.; Vanenkevort, Erin; Varun, Samji; Young, Amanda; Ordoñez, Irina Correa; Brown, Jason; Wojtowicz, Mark

doi:10.1177/10499091221123049

Cited by 3 publications

(4 citation statements)

References 29 publications

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“…Recollection of weight data after months is reported to be less reliable 28 . A previous study conducted in patients with pancreatic cancer suggests that postdiagnosis weight loss over 60 days did not predict poor prognosis 32 . Because we also employed a short time frame, these results support the superiority of our timing strategy in this study.…”

Section: Discussionsupporting

confidence: 77%

“… 28 A previous study conducted in patients with pancreatic cancer suggests that postdiagnosis weight loss over 60 days did not predict poor prognosis. 32 Because we also employed a short time frame, these results support the superiority of our timing strategy in this study. Future studies need to explore the prognostic significance of more weight change time frames that vary in length and timing.…”

Section: Discussionsupporting

confidence: 70%

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Exploring the optimal indicator of short‐term peridiagnosis weight dynamics to predict cancer survival: A multicentre cohort study

Yin,

Zhang,

et al. 2024

J cachexia sarcopenia muscle

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BackgroundBody weight and its changes have been associated with cancer outcomes. However, the associations of short‐term peridiagnosis weight dynamics in standardized, clinically operational time frames with cancer survival remain largely unknown. This study aimed to screen for and evaluate the optimal indicator of short‐term peridiagnosis weight dynamics to predict overall survival (OS) in patients with cancer.MethodsThis multicentre cohort study prospectively collected data from 7460 patients pathologically diagnosed with cancer between 2013 and 2019. Body weight data were recorded 1 month before, at the time of and 1 month following diagnosis. By permuting different types (point value in kg, point height‐adjusted value in kg/m2, absolute change in kg or relative change in percentage) and time frames (prediagnosis, postdiagnosis or peridiagnosis), we generated 12 different weight‐related indicators and compared their prognostic performance using Harrell's C‐index, integrated discrimination improvement, continuous net reclassification improvement and time‐dependent C‐index. We analysed associations of peridiagnosis relative weight change (RWC) with OS using restricted cubic spine (RCS), Kaplan–Meier analysis and multivariable‐adjusted Cox regression models.ResultsThe study enrolled 5012 males and 2448 females, with a median age of 59 years. During a median follow‐up of 37 months, 1026 deaths occurred. Peridiagnosis (1 month before diagnosis to 1 month following diagnosis) RWC showed higher prognostic performance (Harrell's C‐index = 0.601, 95% confidence interval [CI] = [0.583, 0.619]) than other types of indicators including body mass index (BMI), absolute weight change, absolute BMI change, prediagnosis RWC and postdiagnosis RWC in the study population (all P < 0.05). Time‐dependent C‐index analysis also indicated that peridiagnosis RWC was optimal for predicting OS. The multivariable‐adjusted RCS analysis revealed an N‐shaped non‐linear association between peridiagnosis RWC and OS (PRWC < 0.001, Pnon‐linear < 0.001). Univariate survival analysis showed that the peridiagnosis RWC groups could represent distinct mortality risk stratifications (P < 0.001). Multivariable survival analysis showed that, compared with the maintenance group (weight change < 5%), the significant (gain >10%, hazard ratio [HR] = 0.530, 95% CI = [0.413, 0.680]) and moderate (gain 5–10%, HR = 0.588, 95% CI = [0.422, 0.819]) weight gain groups were both associated with improved OS. In contrast, the moderate (loss 5–10%, HR = 1.219, 95% CI = [1.029, 1.443]) and significant (loss >10%, HR = 1.280, 95% CI = [1.095, 1.497]) weight loss groups were both associated with poorer OS.ConclusionsThe prognostic performance of peridiagnosis RWC is superior to other weight‐related indicators in patients with cancer. The findings underscore the importance of expanding the surveillance of body weight from at diagnosis to both past and future, and conducting it within clinically operational time frames, in order to identify and intervene with patients who are at risk of weight change‐related premature deaths.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 70%

Exploring the optimal indicator of short‐term peridiagnosis weight dynamics to predict cancer survival: A multicentre cohort study

Yin,

Zhang,

et al. 2024

J cachexia sarcopenia muscle

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“…There seems to be no consensus among different studies on how weight change affects the prognosis of PC. (19)(20)(21) The conclusion of the effect of skeletal muscle on the prognosis of PC seems to be more consistent. (22)(23)(24)(25) In our study, skeletal muscle change was identi ed as a prognostic factor in PFS nomograms by LASSO Cox regression analysis, whereas weight change only showed borderline signi cance in the nal model of OS.…”

Section: Disscusionmentioning

confidence: 87%

Development and validation of a novel nutrition-based nomogram to predict prognosis in pancreatic cancer patients receiving first-line systemic chemotherapy from three centres.

Zheng,

2023

Preprint

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Background According to clinical trials, the median survival time of patients with advanced pancreatic cancer does not exceed 1 year. There are great differences in prognosis between different patients with pancreatic cancer, and their nutritional status may play a role. In our study, we sought to explore the predictive value of body composition and weight alteration during chemotherapy. Methods In this retrospective study, 90 patients from 3 hospitals with metastatic or locally advanced unresectable pancreatic cancer treated with chemotherapy were analysed. The changes in weight and skeletal muscle index (SMI) and other clinical characteristics were evaluated with LASSO Cox regression and multivariate Cox regression analysis, which were applied to construct nomograms. The performance of the nomograms was validated internally by using the bootstrap method with 100 resample models and was assessed by the concordance index (C-index), calibration plots, and decision curve analysis (DCA). Results The median progression-free survival (PFS) and overall survival (OS) were 5.9 months and 11.8 months, respectively. Liver metastases, local therapy, operation, L3SMI change per 2 months and CD4:CD8 ratio were identified for PFS, while CA19-9, local therapy, operation, weight change per 2 months and CD4:CD8 ratio were identified for OS. The C-index for the nomograms of PFS and OS were 0.709 and 0.755, respectively. Conclusion Nomograms were developed from clinical features and nutritional indicators to predict the probability of achieving 2-month and 4-month PFS and 6-month and 12-month OS with chemotherapy for advanced PC. In advanced pancreatic cancer with limited treatment options, screening for patients who may benefit from chemotherapy is important.

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“…Davis et al retrospectively reported that weight loss over 60 days during chemotherapy, but not at diagnosis, did not predict a poor prognosis in 93 patients with PC. 18 On the other hand, Yildirim et al reported that a weight loss of 3.1% during chemoradiotherapy was an independent predictor of poor survival in 73 patients with locally advanced PC treated with chemoradiotherapy. 19 These conflicting results suggest that weight loss and survival may result from multiple factors.…”

Section: Discussionmentioning

confidence: 99%

Impact of Initial Body Weight Loss on Prognosis in Advanced Pancreatic Cancer: Insights From a Single-Center Retrospective Study

Hosokawa,

Nishida,

Hayashi

et al. 2023

Cancer Control

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Background Pancreatic cancer (PC) has a poor prognosis, with body weight loss commonly observed at diagnosis. However, the impact on PC prognosis of weight loss at the time of diagnosis on PC prognosis is unknown. Methods This retrospective, single-center study enrolled consecutively patients diagnosed with metastatic or locally advanced PC or resectable PC who were intolerant of or refused surgery. Patients who had lost more than 5% of their body weight or more than 2% and had a body mass index (BMI) of less than 20 kg/m2 at diagnosis were classified as experiencing body weight loss. Patients were subclassified into 2 groups: patients with and without weight loss. The study evaluated patient-related and PC-related factors affecting prognosis. Cox proportional hazards models were used to assess factors affecting prognosis. The primary endpoint was overall survival. Additionally, 1:1 propensity score matching was performed to reduce bias. Results In total, 220 patients were included in the study. The median age of the patients was 74 years, and 49.1% were male. Weight loss at diagnosis was observed in 43.2% of patients. There were no significant differences in clinical factors, except for anthropometric parameters, between the groups. The median survival time did not differ between the weight loss and no weight loss groups (149 and 173 days, respectively, P = .669). After matching, no significant differences in survival times were observed between the 2 groups. Conclusions This study found no association between weight loss at diagnosis and prognosis in patients with advanced PC treated with best supportive care or chemotherapy.

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Is Weight Loss During Chemotherapy for Pancreatic Cancer Prognostic?

Cited by 3 publications

References 29 publications

Exploring the optimal indicator of short‐term peridiagnosis weight dynamics to predict cancer survival: A multicentre cohort study

Exploring the optimal indicator of short‐term peridiagnosis weight dynamics to predict cancer survival: A multicentre cohort study

Development and validation of a novel nutrition-based nomogram to predict prognosis in pancreatic cancer patients receiving first-line systemic chemotherapy from three centres.

Impact of Initial Body Weight Loss on Prognosis in Advanced Pancreatic Cancer: Insights From a Single-Center Retrospective Study

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