Jonathan J Hue1, Lee M Ocuin2, Ravi K Kyasaram2, John Shanahan2, Goutham Rao3, Luke D Rothermel2, John B Ammori2, Jeffrey M Hardacre2, Jordan M Winter2, Sarah C Markt4. 1. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Jonathan.Hue@UHHospitals.org. 2. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. 3. Department of Family Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. 4. Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Abstract
BACKGROUND: Objective measures of post-pancreatectomy weight change for pancreatic ductal adenocarcinoma (PDAC) have not been extensively studied for long-term outcomes. We used weight measurements in our institutional medical record to analyze trends in post-pancreatectomy weight and determine the association with disease status. METHODS: Pancreatectomies for PDAC (n = 315) and benign indications (n = 111) were identified. Preoperative baseline, minimum postoperative (Min #1), and subsequent postoperative maximum (Max) weights were abstracted. Multivariable Cox hazards regression was conducted to analyze the association between weight change and survival. RESULTS: Median weight loss postoperatively in each group was > 20 lbs. PDAC patients gained 10 lbs after Min #1 compared to 15 lbs in the benign cohort (p < 0.001). Few patients returned to their preoperative weight (29.8% PDAC vs. 40.5% benign, p = 0.04). Patients with early PDAC recurrence (< 13 months) lost more weight (18.0% vs. 13.3% vs. 10.9%, p < 0.001) and gained less weight (2.1% vs. 12.0% vs. 7.9%, p < 0.001) compared with those with late cancer recurrence (≥ 13 months) or no evidence of active disease, respectively. PDAC patients lost 11.2 lbs in the year preceding recurrence diagnosis. Weight loss was not associated with survival; however, weight gain was associated with improved survival. CONCLUSIONS: Resections for PDAC are complicated by a similar degree of weight loss as patients with benign disease, and there is no association with survival. However, failure to gain weight is especially ominous. Weight loss after weight recovery foreshadows disease recurrence. These data suggest that rigorous weight tracking is an untapped surveillance strategy in patients with PDAC.
BACKGROUND: Objective measures of post-pancreatectomy weight change for pancreatic ductal adenocarcinoma (PDAC) have not been extensively studied for long-term outcomes. We used weight measurements in our institutional medical record to analyze trends in post-pancreatectomy weight and determine the association with disease status. METHODS: Pancreatectomies for PDAC (n = 315) and benign indications (n = 111) were identified. Preoperative baseline, minimum postoperative (Min #1), and subsequent postoperative maximum (Max) weights were abstracted. Multivariable Cox hazards regression was conducted to analyze the association between weight change and survival. RESULTS: Median weight loss postoperatively in each group was > 20 lbs. PDAC patients gained 10 lbs after Min #1 compared to 15 lbs in the benign cohort (p < 0.001). Few patients returned to their preoperative weight (29.8% PDAC vs. 40.5% benign, p = 0.04). Patients with early PDAC recurrence (< 13 months) lost more weight (18.0% vs. 13.3% vs. 10.9%, p < 0.001) and gained less weight (2.1% vs. 12.0% vs. 7.9%, p < 0.001) compared with those with late cancer recurrence (≥ 13 months) or no evidence of active disease, respectively. PDAC patients lost 11.2 lbs in the year preceding recurrence diagnosis. Weight loss was not associated with survival; however, weight gain was associated with improved survival. CONCLUSIONS: Resections for PDAC are complicated by a similar degree of weight loss as patients with benign disease, and there is no association with survival. However, failure to gain weight is especially ominous. Weight loss after weight recovery foreshadows disease recurrence. These data suggest that rigorous weight tracking is an untapped surveillance strategy in patients with PDAC.
Authors: Alessandro Paniccia; Patrick Hosokawa; William Henderson; Richard D Schulick; Barish H Edil; Martin D McCarter; Csaba Gajdos Journal: JAMA Surg Date: 2015-08 Impact factor: 14.766
Authors: Vincent P Groot; Neda Rezaee; Wenchuan Wu; John L Cameron; Elliot K Fishman; Ralph H Hruban; Matthew J Weiss; Lei Zheng; Christopher L Wolfgang; Jin He Journal: Ann Surg Date: 2018-05 Impact factor: 12.969
Authors: Christine A Iacobuzio-Donahue; Baojin Fu; Shinichi Yachida; Mingde Luo; Hisashi Abe; Clark M Henderson; Felip Vilardell; Zheng Wang; Jesse W Keller; Priya Banerjee; Joseph M Herman; John L Cameron; Charles J Yeo; Marc K Halushka; James R Eshleman; Marian Raben; Alison P Klein; Ralph H Hruban; Manuel Hidalgo; Daniel Laheru Journal: J Clin Oncol Date: 2009-03-09 Impact factor: 44.544
Authors: Helmut Oettle; Peter Neuhaus; Andreas Hochhaus; Jörg Thomas Hartmann; Klaus Gellert; Karsten Ridwelski; Marco Niedergethmann; Carl Zülke; Jörg Fahlke; Michael B Arning; Marianne Sinn; Axel Hinke; Hanno Riess Journal: JAMA Date: 2013-10-09 Impact factor: 56.272
Authors: Thomas Schnelldorfer; Adam L Ware; Michael G Sarr; Thomas C Smyrk; Lizhi Zhang; Rui Qin; Rachel E Gullerud; John H Donohue; David M Nagorney; Michael B Farnell Journal: Ann Surg Date: 2008-03 Impact factor: 12.969
Authors: J L Humphris; D K Chang; A L Johns; C J Scarlett; M Pajic; M D Jones; E K Colvin; A Nagrial; V T Chin; L A Chantrill; J S Samra; A J Gill; J G Kench; N D Merrett; A Das; E A Musgrove; R L Sutherland; A V Biankin Journal: Ann Oncol Date: 2012-01-11 Impact factor: 32.976
Authors: Azadeh Azizian; Felix Rühlmann; Tanja Krause; Markus Bernhardt; Peter Jo; Alexander König; Mathias Kleiß; Andreas Leha; Michael Ghadimi; Jochen Gaedcke Journal: Sci Rep Date: 2020-01-28 Impact factor: 4.379
Authors: Jordan M Winter; Laura H Tang; David S Klimstra; Murray F Brennan; Jonathan R Brody; Flavio G Rocha; Xiaoyu Jia; Li-Xuan Qin; Michael I D'Angelica; Ronald P DeMatteo; Yuman Fong; William R Jarnagin; Eileen M O'Reilly; Peter J Allen Journal: PLoS One Date: 2012-07-06 Impact factor: 3.240