Impact of nutritional status on chemotherapy delivery and outcomes in advanced pancreatic cancer: A prospective multicenter study
Maria Kiriukova, Gabriele Capurso et al.
Summary
Background & aim
Malnutrition is common in pancreatic ductal adenocarcinoma (PDAC) and may compromise chemotherapy delivery. We investigated whether baseline nutritional status and quality of life (QoL) predict chemotherapy relative dose intensity (RDI) and survival in advanced PDAC.
Methods
In this multicenter prospective cohort, adults with locally advanced or metastatic PDAC planned for first-line chemotherapy underwent baseline nutritional and QoL assessments, including the Mini Nutritional Assessment (MNA), European Organisation for Research and Treatment of Cancer-Pancreas 26 (EORTC-PAN26), and Functional Assessment of Anorexia/Cachexia Therapy subscale (FAACT-A/CS). The primary outcome was chemotherapy delivery during the first 12 weeks, expressed as RDI. Secondary outcomes included overall survival (OS). Associations between baseline scores, RDI, and OS were analyzed using regression models adjusted for age, sex, disease stage, and center. Kaplan–Meier and Cox models assessed survival.
Results
Of 140 enrolled patients, 105 started chemotherapy. Malnutrition was frequent (55.7 % at risk, 33.6 % malnourished). Higher MNA and EORTC-PAN26 scores were associated with better RDI (r = 0.31, p = 0.001; r = 0.30, p = 0.002), whereas FAACT-A/CS showed no correlation. In multivariable analysis, higher MNA scores [odds ratio (OR) 0.55; 95 % confidence interval (CI) 0.32–0.96; p = 0.036] and metastatic disease (OR 0.36; 95 % CI 0.13–0.99; p = 0.048) independently predicted RDI ≥80 %. Reduced RDI (hazard ratio [HR] 2.05; 95 % CI 1.20–3.50; p = 0.009) and FAACT-A/CS < 28 (HR 1.90; 95 % CI 1.04–3.49) were independently associated with shorter OS.
Conclusions
Baseline nutritional status and QoL, particularly assessed by MNA and EORTC-PAN26, predict chemotherapy delivery in advanced PDAC. Reduced RDI and anorexia/cachexia symptoms are linked to poorer survival, supporting systematic nutritional assessment and targeted interventions to optimize outcomes.
Section snippets
Background
Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal malignancy with steadily increasing incidence worldwide and is projected to become the second leading cause of cancer-related mortality in Western countries [[1], [2], [3]]. Despite therapeutic advances, the 5-year survival rate remains close to 10 % [[1], [2], [3]], with most patients presenting unresectable locally advanced or metastatic disease at diagnosis, amenable to exclusive palliative treatment [4,5].
Beyond tumor
Materials and methods
This multicenter, prospective observational cohort study was conducted within Pancreas 2000, a postgraduate educational program for young pancreatologists under the patronage of the European Pancreatic Club. The study protocol was registered at ClinicalTrials.gov (NCT04112836), previously published [15], and first approved by the Local Ethics Committee of the leading center, A.S. Loginov Moscow Clinical Scientific Center, Russia (No. 2/2019, February 18, 2019), and subsequently by the
Study cohort
Between March 2019 and May 2021, 140 patients were recruited, provided consent, and underwent baseline nutritional evaluation, being considered fit for chemotherapy. The median age was 64.9 years (range 32.7–80.5), with a slight female predominance; 71.4 % had metastatic and 25.7 % locally advanced disease; 62.9 % had tumors in the pancreatic head. Although the mean BMI was 24, only 10.7 % (n = 15) had a normal MNA score (≥12), while 55.7 % were at risk of malnutrition (score 8–11) and 33.6 %
Discussion
This multicenter prospective study shows that baseline nutritional status and quality of life influence chemotherapy delivery in advanced PDAC. Higher MNA and EORTC-PAN26 scores were associated with higher RDI, with MNA remaining significant in multivariable analysis. As expected, reduced RDI [13,14] and worse FAACT–A/CS scores were associated with shorter survival, highlighting chemotherapy delivery and symptom severity related to appetite and eating, as potential mediators between nutritional
Conclusion
In conclusion, baseline nutritional status and QoL are key determinants of chemotherapy delivery in advanced PDAC, with RDI emerging as a clinically relevant mediator of survival [13,14]. Differences between nutritional and QoL instruments reflect their distinct conceptual targets: global nutritional status predicts treatment feasibility, whereas functional symptom scores relate more closely to overall prognosis [20,25,27]. These findings support early nutritional and symptomatic assessment and
