Clinical Impact of Neoadjuvant Therapy on Nutritional Status in Pancreatic Cancer

• Published in: Annals of surgical oncology Vol. 25; no. 11; pp. 3365 - 3371
• Main Authors: Tashiro, Mitsuru, Yamada, Suguru, Sonohara, Fuminori, Takami, Hideki, Suenaga, Masaya, Hayashi, Masamichi, Niwa, Yukiko, Tanaka, Chie, Kobayashi, Daisuke, Nakayama, Goro, Koike, Masahiko, Fujiwara, Michitaka, Fujii, Tsutomu, Kodera, Yasuhiro
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-10-2018; Springer Nature B.V
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Female; Follow-Up Studies; Humans; Immunological tolerance; Inflammation; Inflammation Mediators - metabolism; Length of Stay; Male; Malnutrition; Malnutrition - etiology; Malnutrition - pathology; Medicine; Medicine & Public Health; Neoadjuvant Therapy - adverse effects; Nutritional Status; Oncology; Pancreatic cancer; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreatic Tumors; Pancreaticoduodenectomy; Pancreaticoduodenectomy - adverse effects; Prognosis; Retinol-binding protein; Surgery; Surgical Oncology; Vitamin A; Rapid Protein Turnover (RTPs); Pancreatic Cancer; Prognostic Nutritional Index (PNI); Inflammation-based Prognostic Score; Retinol-binding Protein
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-018-6699-8

Background
The association between neoadjuvant therapy (NAT) and nutritional status in pancreatic cancer (PC) is unknown.
Objective
The aim of this study was to assess the impact of NAT on nutritional status.
Methods
Overall, 161 patients who underwent pancreatoduodenectomy for PC between August 2010 and March 2017 were enrolled and were divided into two groups: the neoadjuvant group (NAG;
n
 = 67) and the control group (CG;
n
 = 94). Based on relative dose intensity (RDI), patients in the NAG group were further divided into RDI ≥ 80% (
n
 = 39) and RDI < 80% (
n
 = 19). Changes in nutritional index, inflammatory index, and inflammation-based prognostic scores during NAT and the perioperative period were assessed.
Results
Retinol-binding protein, prealbumin, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutrition index significantly worsened in the NAG after NAT (
p
 = 0.007,
p
 = 0.03,
p
 = 0.04,
p
 = 0.007, and
p
 = 0.004, respectively). The recovery of rapid turnover proteins after postoperative day 5 was significantly worse in the NAG compared with the CG (
p
 < 0.05), but tended to be more prompt in the RDI ≥ 80% group among the NAG. There was no significant difference in the incidence of postoperative complications, length of hospital stay, and time to postoperative adjuvant therapy between the NAG and the CG.
Conclusions
NAT for PC could aggravate nutritional status and hamper its postoperative recovery. Furthermore, malnutrition might decrease tolerance of NAT. These findings suggest the importance of nutritional support for patients with NAT in PC.