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Erschienen in: Annals of Surgical Oncology 11/2018

10.08.2018 | Pancreatic Tumors

Clinical Impact of Neoadjuvant Therapy on Nutritional Status in Pancreatic Cancer

verfasst von: Mitsuru Tashiro, MD, Suguru Yamada, MD, PhD, Fuminori Sonohara, MD, PhD, Hideki Takami, MD, PhD, Masaya Suenaga, MD, PhD, Masamichi Hayashi, MD, PhD, Yukiko Niwa, MD, PhD, Chie Tanaka, MD, PhD, Daisuke Kobayashi, MD, PhD, Goro Nakayama, MD, PhD, Masahiko Koike, MD, PhD, Michitaka Fujiwara, MD, PhD, Tsutomu Fujii, MD, PhD, Yasuhiro Kodera, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 11/2018

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Abstract

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.
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Literatur
1.
Zurück zum Zitat Yamada S, Fujii T, Sugimoto H, Nomoyo S, Takeda S, Kodera Y, et al. Aggressive surgery for borderline resectable pancreatic cancer: evaluation of National Comprehensive Cancer Network guidelines. Pancreas. 2013;42(6):1004–1010.CrossRef Yamada S, Fujii T, Sugimoto H, Nomoyo S, Takeda S, Kodera Y, et al. Aggressive surgery for borderline resectable pancreatic cancer: evaluation of National Comprehensive Cancer Network guidelines. Pancreas. 2013;42(6):1004–1010.CrossRef
2.
Zurück zum Zitat Warshaw AL, Fernández-del CC. Pancreatic carcinoma. N Engl J Med. 1992;326:455–465.CrossRef Warshaw AL, Fernández-del CC. Pancreatic carcinoma. N Engl J Med. 1992;326:455–465.CrossRef
3.
Zurück zum Zitat Conlon KC, Klimstra S, Brennan MF. Long-term survival after curative resection for pancreatic ductal carcinoma. Clinicopathologic analysis of 5-year survivors. Ann Surg. 1996;223:273–279.CrossRef Conlon KC, Klimstra S, Brennan MF. Long-term survival after curative resection for pancreatic ductal carcinoma. Clinicopathologic analysis of 5-year survivors. Ann Surg. 1996;223:273–279.CrossRef
4.
Zurück zum Zitat Vincent A, Herman J, Schulick R, Hruban RH, Goggins M. Pancreatic cancer. Lancet. 2016;388(10039):73–85.CrossRef Vincent A, Herman J, Schulick R, Hruban RH, Goggins M. Pancreatic cancer. Lancet. 2016;388(10039):73–85.CrossRef
5.
Zurück zum Zitat Yamada S, Fujii T, Kanda M, et al. Value of peritoneal cytology in potentially resectable pancreatic cancer. Br J Surg. 2013;100(13):1791–1796.CrossRef Yamada S, Fujii T, Kanda M, et al. Value of peritoneal cytology in potentially resectable pancreatic cancer. Br J Surg. 2013;100(13):1791–1796.CrossRef
6.
Zurück zum Zitat Yamada S, Fujii T, Sugimoto H, et al. Pancreatic cancer with distant metastases: a contraindication for radical surgery? Hepatogastroenterology. 2009;56(91–92):881–885.PubMed Yamada S, Fujii T, Sugimoto H, et al. Pancreatic cancer with distant metastases: a contraindication for radical surgery? Hepatogastroenterology. 2009;56(91–92):881–885.PubMed
7.
Zurück zum Zitat Yamada S, Nakao A, Fujii T, et al. Pancreatic cancer with paraaortic lymph node metastasis: a contraindication for radical surgery? Pancreas. 2009;38(1):e13–e17.CrossRef Yamada S, Nakao A, Fujii T, et al. Pancreatic cancer with paraaortic lymph node metastasis: a contraindication for radical surgery? Pancreas. 2009;38(1):e13–e17.CrossRef
8.
Zurück zum Zitat Smeenk HG, van Eick CH, Hop WC, et al. Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891. Ann Surg. 2007;246:734–740.CrossRef Smeenk HG, van Eick CH, Hop WC, et al. Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891. Ann Surg. 2007;246:734–740.CrossRef
9.
Zurück zum Zitat Gillen S, Schuster T, Meyer Zum Büschenfelde C, Friess H, Kleff J. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010;7(4):e1000267.CrossRef Gillen S, Schuster T, Meyer Zum Büschenfelde C, Friess H, Kleff J. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010;7(4):e1000267.CrossRef
10.
Zurück zum Zitat Satoi S, Yanagimoto H, Toyokawa H, et al. Surgical results after preoperative chemoradiation therapy for patients with pancreatic cancer. Pancreas. 2009;38:282–288.CrossRef Satoi S, Yanagimoto H, Toyokawa H, et al. Surgical results after preoperative chemoradiation therapy for patients with pancreatic cancer. Pancreas. 2009;38:282–288.CrossRef
11.
Zurück zum Zitat Habermehl D, Kessel K, Welzel T, et al. Neoadjuvant chemoradiation with Gemcitabine for locally advanced pancreatic cancer. Radiat Oncol. 2012;7:28.CrossRef Habermehl D, Kessel K, Welzel T, et al. Neoadjuvant chemoradiation with Gemcitabine for locally advanced pancreatic cancer. Radiat Oncol. 2012;7:28.CrossRef
12.
Zurück zum Zitat Tinkl D, Grabenbauer GG, Golcher H, et al. Downstaging of pancreatic carcinoma after neoadjuvant chemoradiation. Strahlenther Onkol. 2009;185:557–566.CrossRef Tinkl D, Grabenbauer GG, Golcher H, et al. Downstaging of pancreatic carcinoma after neoadjuvant chemoradiation. Strahlenther Onkol. 2009;185:557–566.CrossRef
13.
Zurück zum Zitat Andreyev H, Norman A, Oates J, Cunningham D. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer. 1998;34(4);503–509.CrossRef Andreyev H, Norman A, Oates J, Cunningham D. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer. 1998;34(4);503–509.CrossRef
14.
Zurück zum Zitat Braga M, Gianotti L, Nespoli L, Radaelli G, Di Carlo V. Nutritional Approach in Malnourished Surgical Patients. Arch Surg. 2002;137:174–180.CrossRef Braga M, Gianotti L, Nespoli L, Radaelli G, Di Carlo V. Nutritional Approach in Malnourished Surgical Patients. Arch Surg. 2002;137:174–180.CrossRef
15.
Zurück zum Zitat Braga M, Gianotti L, Cestari A, Profili M, Carlo VD. Immune and nutritional effects of early enteral nutrition after major abdominal operations. Eur J Surg. 1996;162:105–112.PubMed Braga M, Gianotti L, Cestari A, Profili M, Carlo VD. Immune and nutritional effects of early enteral nutrition after major abdominal operations. Eur J Surg. 1996;162:105–112.PubMed
16.
Zurück zum Zitat Aida T, Furukawa K, Suzuki D, et al. Preoperative immunonutrition decreases postoperative complications by modulating prostaglandin E2 production and T-cell differentiation in patients undergoing pancreatoduodenectomy. Surgery. 2014;155:124–133.CrossRef Aida T, Furukawa K, Suzuki D, et al. Preoperative immunonutrition decreases postoperative complications by modulating prostaglandin E2 production and T-cell differentiation in patients undergoing pancreatoduodenectomy. Surgery. 2014;155:124–133.CrossRef
17.
Zurück zum Zitat Miyata H, Yano M, Yasuda T, et al. Randomized study of clinical effect of enteral nutrition support during neoadjuvant chemotherapy on chemotherapy-related toxicity in patients with esophageal cancer. Clin Nutr. 2012;31:330–336.CrossRef Miyata H, Yano M, Yasuda T, et al. Randomized study of clinical effect of enteral nutrition support during neoadjuvant chemotherapy on chemotherapy-related toxicity in patients with esophageal cancer. Clin Nutr. 2012;31:330–336.CrossRef
18.
Zurück zum Zitat Naumann P, Haermehl D, Welzel T, Debus J, Combs SE. Outcome after neoadjuvant chemoradiation and correlation with nutritional status in patients with locally advanced pancreatic cancer. Strahlenther Onkol. 2013;189:745–752.CrossRef Naumann P, Haermehl D, Welzel T, Debus J, Combs SE. Outcome after neoadjuvant chemoradiation and correlation with nutritional status in patients with locally advanced pancreatic cancer. Strahlenther Onkol. 2013;189:745–752.CrossRef
19.
Zurück zum Zitat Sho M, Akahori T, Tanaka T, et al. Pathological and clinical impact of neoadjuvant chemoradiotherapy using full-dose gemcitabine and concurrent radiation for resectable pancreatic cancer. J Hepatobiliary Pancreat Sci. 2013;20:197–205.CrossRef Sho M, Akahori T, Tanaka T, et al. Pathological and clinical impact of neoadjuvant chemoradiotherapy using full-dose gemcitabine and concurrent radiation for resectable pancreatic cancer. J Hepatobiliary Pancreat Sci. 2013;20:197–205.CrossRef
20.
Zurück zum Zitat Heinrich S, Pestalozzi BC, Schäfer M, Weber A, Bauerfeind P, Knuth A, et al. Prospective phase II trial of neoadjuvant chemotherapy with Gemcitabine and Cisplatin for resectable adenocarcinoma of the `pancreatic head. J Clin Oncol. 2008;26(15):2526–2531.CrossRef Heinrich S, Pestalozzi BC, Schäfer M, Weber A, Bauerfeind P, Knuth A, et al. Prospective phase II trial of neoadjuvant chemotherapy with Gemcitabine and Cisplatin for resectable adenocarcinoma of the `pancreatic head. J Clin Oncol. 2008;26(15):2526–2531.CrossRef
21.
Zurück zum Zitat Hryniuk W, Bush H. The importance of dose intensity in chemotherapy of metastatic breast cancer. J Clin Oncol. 1984;2(11):1281–1288.CrossRef Hryniuk W, Bush H. The importance of dose intensity in chemotherapy of metastatic breast cancer. J Clin Oncol. 1984;2(11):1281–1288.CrossRef
22.
Zurück zum Zitat Yabusaki N, Fujii T, Yamada S, et al. The significance of relative dose intensity in adjuvant chemotherapy of pancreatic ductal adenocarcinoma—including the analysis of clinicopathological factors influencing relative dose intensity. Medicine (Baltimore). 2016;95(29):e4282.CrossRef Yabusaki N, Fujii T, Yamada S, et al. The significance of relative dose intensity in adjuvant chemotherapy of pancreatic ductal adenocarcinoma—including the analysis of clinicopathological factors influencing relative dose intensity. Medicine (Baltimore). 2016;95(29):e4282.CrossRef
23.
Zurück zum Zitat Rey-Ferro M, Castaño R, Orozco O, Serna A, Moreno A. Nutritional and immunologic evaluation of patients with gastric cancer before and after surgery. Nutrition. 1997;13:878–881.CrossRef Rey-Ferro M, Castaño R, Orozco O, Serna A, Moreno A. Nutritional and immunologic evaluation of patients with gastric cancer before and after surgery. Nutrition. 1997;13:878–881.CrossRef
24.
Zurück zum Zitat van Bokhorst-de van der Schuer MAE, van Leeuwen PA, Kuik DJ, Klop WM, Sauerwein HP, Snow GB, Quak JJ. The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer. 1999;86:519–527.CrossRef van Bokhorst-de van der Schuer MAE, van Leeuwen PA, Kuik DJ, Klop WM, Sauerwein HP, Snow GB, Quak JJ. The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer. 1999;86:519–527.CrossRef
25.
Zurück zum Zitat Sandström R, Drott C, Hyltander A, Arfvidsson B, Scherstén T, Wickström I, et al. The effect of postoperative intravenous feeding (TPN) on outcome following major surgery evaluated in a randomized study. Ann Surg. 1993;217:185–195.CrossRef Sandström R, Drott C, Hyltander A, Arfvidsson B, Scherstén T, Wickström I, et al. The effect of postoperative intravenous feeding (TPN) on outcome following major surgery evaluated in a randomized study. Ann Surg. 1993;217:185–195.CrossRef
26.
Zurück zum Zitat Yamada S, Fujii T, Yabusaki N, et al. Clinical implication of inflammation-based prognostic score in pancreatic cancer: Glasgow Prognostic score is the most reliable parameter. Medicine. 2016;95(18):e3582.CrossRef Yamada S, Fujii T, Yabusaki N, et al. Clinical implication of inflammation-based prognostic score in pancreatic cancer: Glasgow Prognostic score is the most reliable parameter. Medicine. 2016;95(18):e3582.CrossRef
27.
Zurück zum Zitat Martin HL, Ohara K, Kiberu A, Van Hagen T, Davidson A, Khattak MA. Prognostic value of systemic inflammation-based markers in advanced pancreatic cancer. Intern Med J. 2014;44(7):676–682.CrossRef Martin HL, Ohara K, Kiberu A, Van Hagen T, Davidson A, Khattak MA. Prognostic value of systemic inflammation-based markers in advanced pancreatic cancer. Intern Med J. 2014;44(7):676–682.CrossRef
Metadaten
Titel
Clinical Impact of Neoadjuvant Therapy on Nutritional Status in Pancreatic Cancer
verfasst von
Mitsuru Tashiro, MD
Suguru Yamada, MD, PhD
Fuminori Sonohara, MD, PhD
Hideki Takami, MD, PhD
Masaya Suenaga, MD, PhD
Masamichi Hayashi, MD, PhD
Yukiko Niwa, MD, PhD
Chie Tanaka, MD, PhD
Daisuke Kobayashi, MD, PhD
Goro Nakayama, MD, PhD
Masahiko Koike, MD, PhD
Michitaka Fujiwara, MD, PhD
Tsutomu Fujii, MD, PhD
Yasuhiro Kodera, MD, PhD
Publikationsdatum
10.08.2018
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 11/2018
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6699-8

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