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Weight Loss as an Untapped Early Detection Marker in Pancreatic and Periampullary Cancer

  • Pancreatic Tumors
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Abstract

Background

Pancreatic ductal adenocarcinoma (PDAC) has the worst survival of common cancers, partly because there are no reliable early detection tests. Unintentional weight loss (≥ 5% decrease from baseline) has been linked to PDAC, but the frequency and severity of weight loss using objective measures, and its relationship to prognosis, have not been well characterized.

Methods

We identified 390 patients with PDAC (all stages) and two or more prediagnosis weights in the electronic medical record. Percentage weight loss in the 365 and 180 days preceding diagnosis was calculated. Results were compared with raw weights of age- and sex-matched non-cancer controls (n = 780). Odds ratios for PDAC were calculated using conditional logistic regression. Cox proportional hazards models were used for survival.

Results

Within 1 year of diagnosis, more PDAC patients lost ≥ 5% weight relative to controls (74.9% vs. 11.2%; p < 0.001), with a median weight loss of 14.2 versus 2.9 lbs. The odds ratio for PDAC comparing weight loss within 1 year of 5 to < 10% was 10.30 (p < 0.001) and 77.82 for ≥ 10% (p < 0.001), compared with stable weight. Weight loss prior to diagnosis was also associated with early-stage PDAC. PDAC cases with ≥ 10% prediagnosis weight loss had worse survival compared with stable weights (hazard ratio [HR] 1.60; p = 0.01). Greater prediagnosis weight loss was associated with poor survival after pancreatectomy (5 to < 10% vs. < 5%, HR 2.40, p = 0.03; ≥ 10% vs. < 5%, HR 2.59, p = 0.03).

Conclusions

Diagnosis of PDAC is preceded by unintentional weight loss in the majority of patients, even at an early stage. Greater prediagnosis weight loss severity is also associated with poor postoperative survival.

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Acknowledgment

This work was supported by the University Hospitals Ventures START (Stimulation of Teams, and Activation of Resources and Tools) Fund, with support and guidance from the University Hospitals Research Health Analytics and Informatics Program.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Jonathan J. Hue MD, Kavin Sugumar MD, Ravi K. Kyasaram MS, John Shanahan BA, Joshua Lyons MD, Luke D. Rothermel MD, Jeffrey M. Hardacre MD, John B. Ammori MD & Jordan M. Winter MD

  2. Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Atrium Health, Charlotte, NC, USA

    Lee M. Ocuin MD

  3. Department of Family Medicine, University Hospitals, Cleveland, OH, USA

    Goutham Rao MD

  4. Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Sarah C. Markt ScD, MPH

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  1. Jonathan J. Hue MD
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Correspondence to Jonathan J. Hue MD.

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Hue, J.J., Sugumar, K., Kyasaram, R.K. et al. Weight Loss as an Untapped Early Detection Marker in Pancreatic and Periampullary Cancer. Ann Surg Oncol 28, 6283–6292 (2021). https://doi.org/10.1245/s10434-021-09861-8

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