PROGNOSTIC VALUE OF PREOPERATIVE NUTRITIONAL STATUS IN RESECTED PANCREATIC DUCTAL ADENOCARCINOMA: A PROSPECTIVE STUDY

Abstract

To explore the prognostic significance of nutritional status in patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC). Clinical data of non-consecutive patients submitted to surgery for PDAC from 2015 to 2018 at Pancreas Institute of Verona were prospectively collected. Nutritional Risk Screening 2002 (NRS) was performed to assess nutritional risk. Body composition was detected by Bioelectrical Impedance Analysis (BIA) the day before the scheduled surgery. 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. The final cohort consisted of 73 patients (median follow-up 11 months). The majority were at risk of malnutrition (NRS≥3). At multivariate analysis, stage (HR 4.30, p=0.045), NRS (HR 6.51, p=0.017), fat-free mass (FFM) (HR 1.08, p=0.013) were significant independent predictors for OS. Particularly, patients with preoperative NRS≤3 had significantly longer 2-year OS than those with NRS>3 (94% vs 75%, p=0.02). Contrariwise, BMI did not affect OS. Twenty-four patients (32.9%) were treated with neoadjuvant therapy. NRS was significantly higher in this subset of patients (p=0.026), with a significant difference according to chemotherapy regimens (Folfirinox vs Gemcitabine/Nab-paclitaxel) (p=0.035). In patients treated with adjuvant chemotherapy (45.2%), FFM correlated with worse DSF and OS (p=0.039 and p=0.039, respectively). Our analysis suggests that preoperative malnutrition has a detrimental impact on OS in resected PDAC. Preoperative nutritional screening and, possibly, targeted nutritional intervention may improve outcomes in resectable PDAC patients, particularly in those who are candidate to neoadjuvant therapy.