Cachexia-Affected Survival Based on Inflammatory Parameters Compared to Complex Conventional Nutritional Assessments in Patients with Pancreatic Cancer and Other Gastrointestinal Tumors—The CONKO 020 Investigation
by
, , , and
Johanna W. Meyer-Knees
1,
Janina Falkenthal
2,
Dominik Geisel
3,
Christopher C. M. Neumann
4,
Georg Hilfenhaus
4,
Lars U. Stephan
4,
Wenzel Schöning
5,
Thomas Malinka
5,
Johann Pratschke
5,
Sebastian Stintzing
4
and
Uwe Pelzer
4,*
1
Division of Oncology and Hematology, Berlin Institute of Health, Charite Campus Virchow Klinikum, Freie Universität Berlin, Humboldt Universität zu Berlin, 13353 Berlin, Germany
2
KONZ-E-B-T CARE GmbH Zentrum für Ernährung, Beatmung und Therapie, 13435 Berlin, Germany
3
Division of Radiology, Berlin Institute of Health, Charite Campus Virchow Klinikum, Freie Universität Berlin, Humboldt Universität zu Berlin, 13353 Berlin, Germany
4
Division of Oncology and Hematology, Berlin Institute of Health, Charite Campus Mitte, Freie Universität Berlin, Humboldt Universität zu Berlin, 10117 Berlin, Germany
5
Division of Surgery, Berlin Institute of Health, Charite Campus Mitte-Campus Virchow Klinikum, Freie Universität Berlin, Humboldt Universität zu Berlin, 13353 Berlin, Germany
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(6), 1194; https://doi.org/10.3390/cancers16061194
Submission received: 11 February 2024
/
Revised: 11 March 2024
/
Accepted: 11 March 2024
/
Published: 18 March 2024
(This article belongs to the Special Issue Inflammation in Cancers)
Simple Summary
Pancreatic adenocarcinoma is a disease with multifactorial interactions that still has a devastating prognosis. Cachexia symptoms frequently impair patient survival. We commonly diagnose this later in the course of the disease once clinical signs become more evident. Early diagnosis is often difficult using conventional measurements. In the course of the disease, its discrimination from cancer progression is challenging and often overlaps. The aim of this study was to investigate whether conventional nutritional assessments or suitable laboratory parameters better predict the prognosis for cachexia-affected survival. We used established conventional methods, such as clinical and electrophysiological assessments, and compared them with inflammatory laboratory parameters. In addition, we used a control group with other gastrointestinal tumors to differentiate marker specificity. In patients with pancreatic adenocarcinoma, we were able to show that inflammatory parameters as well as albumin can determine the prognosis earlier and more specifically than conventional methods. From this, simpler diagnostic criteria could be derived, which could possibly bring earlier intervention into discussion for subgroups.
Abstract
Background: Pancreatic adenocarcinoma (PDAC) is still a complex, devastating disease. Cachexia symptoms frequently impair patient survival. This accompanying syndrome is commonly diagnosed late, when clinical signs become evident. Early diagnosis using conventional measurement methods is often difficult, and the discrimination of this disease from cancer progression is challenging and often overlaps. The aim of this study was to analyze whether conventional nutritional assessments or laboratory biomarkers are better predictive tools for the early detection of patients at risk of reduced survival. Methods: We analyzed a prospective predefined cohort of 182 patients with gastrointestinal cancer, 120 patients with PDAC and—as controls—62 patients with other gastrointestinal adenocarcinoma (oAC), from whom we have sufficient data of protocol-defined conventional nutritional assessments, clinical data, and specific laboratory parameters. Results: at the time of tumor diagnosis, high inflammatory biomarkers (c-reactive protein (CRP), interleukin-6 (IL-6)) and albumin serum levels were associated with impaired OS in PDAC patients, but not in patients with oAC. Hemoglobin, body mass index (BMI), and bioelectrical assessments alone did not have a prognostic impact at the time of diagnosis. In a multivariate analysis, only CRP (HR 1.91 (1.25–2.92), p = 0.003) was found to be an independent prognostic factor in PDAC patients. Over the course of the disease in PDAC patients, inflammatory biomarkers, albumin, hemoglobin, and bioelectrical assessments were associated with impaired OS. In multivariate testing, CRP (HR 2.21 (1.38–3.55), p < 0.001) and albumin (HR 1.71 (1.05–2.77), p = 0.030) were found to be independent prognostic factors in PDAC patients. Conclusion: Specifically for PDAC patients, high inflammatory index and albumin serum levels potentially represent a sufficient early surrogate marker to detect patients at high risk of impaired OS better than complex conventional methods. These findings could help to identify patients who may benefit from early therapeutic interventions.
