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Annals of Surgical Oncology

, Volume 25, Issue 11, pp 3365–3371 | Cite as

Clinical Impact of Neoadjuvant Therapy on Nutritional Status in Pancreatic Cancer

  • Mitsuru Tashiro
  • Suguru Yamada
  • Fuminori Sonohara
  • Hideki Takami
  • Masaya Suenaga
  • Masamichi Hayashi
  • Yukiko Niwa
  • Chie Tanaka
  • Daisuke Kobayashi
  • Goro Nakayama
  • Masahiko Koike
  • Michitaka Fujiwara
  • Tsutomu Fujii
  • Yasuhiro Kodera
Pancreatic Tumors

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.

Notes

Author Contributions

MT, SY, YK: Conception and design; YK, SY: Administrative support; HT, MS, YN, MH, SY, TF: Provision of study materials and patients; HT, MS, YN, MH, SY, TF: Collection and assembly of data; MT, SY: Interpretation and analysis of data; MT, FS, SY: Manuscript writing; Final approval of manuscript: all authors.

Disclosure

Mitsuru Tashiro, Suguru Yamada, Fuminori Sonohara, Hideki Takami, Masaya Suenaga, Masamichi Hayashi, Yukiko Niwa, Chie Tanaka, Daisuke Kobayashi, Goro Nakayama, Masahiko Koike, Michitaka Fujiwara, Tsutomu Fujii, and Yasuhiro Kodera have no conflicts of interest to declare.

Supplementary material

10434_2018_6699_MOESM1_ESM.pdf (852 kb)
Supplementary material 1 (PDF 852 kb)

References

  1. 1.
    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.CrossRefPubMedGoogle Scholar
  2. 2.
    Warshaw AL, Fernández-del CC. Pancreatic carcinoma. N Engl J Med. 1992;326:455–465.CrossRefPubMedGoogle Scholar
  3. 3.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Vincent A, Herman J, Schulick R, Hruban RH, Goggins M. Pancreatic cancer. Lancet. 2016;388(10039):73–85.CrossRefGoogle Scholar
  5. 5.
    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.CrossRefPubMedGoogle Scholar
  6. 6.
    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.PubMedGoogle Scholar
  7. 7.
    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.CrossRefPubMedGoogle Scholar
  8. 8.
    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.CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Satoi S, Yanagimoto H, Toyokawa H, et al. Surgical results after preoperative chemoradiation therapy for patients with pancreatic cancer. Pancreas. 2009;38:282–288.CrossRefPubMedGoogle Scholar
  11. 11.
    Habermehl D, Kessel K, Welzel T, et al. Neoadjuvant chemoradiation with Gemcitabine for locally advanced pancreatic cancer. Radiat Oncol. 2012;7:28.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Tinkl D, Grabenbauer GG, Golcher H, et al. Downstaging of pancreatic carcinoma after neoadjuvant chemoradiation. Strahlenther Onkol. 2009;185:557–566.CrossRefPubMedGoogle Scholar
  13. 13.
    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.CrossRefPubMedGoogle Scholar
  14. 14.
    Braga M, Gianotti L, Nespoli L, Radaelli G, Di Carlo V. Nutritional Approach in Malnourished Surgical Patients. Arch Surg. 2002;137:174–180.CrossRefPubMedGoogle Scholar
  15. 15.
    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.PubMedGoogle Scholar
  16. 16.
    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.CrossRefPubMedGoogle Scholar
  17. 17.
    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.CrossRefPubMedGoogle Scholar
  18. 18.
    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.CrossRefPubMedGoogle Scholar
  19. 19.
    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.CrossRefPubMedGoogle Scholar
  20. 20.
    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.CrossRefPubMedGoogle Scholar
  21. 21.
    Hryniuk W, Bush H. The importance of dose intensity in chemotherapy of metastatic breast cancer. J Clin Oncol. 1984;2(11):1281–1288.CrossRefPubMedGoogle Scholar
  22. 22.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    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.CrossRefPubMedGoogle Scholar
  24. 24.
    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.Google Scholar
  25. 25.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    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.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Mitsuru Tashiro
    • 1
  • Suguru Yamada
    • 1
  • Fuminori Sonohara
    • 1
  • Hideki Takami
    • 1
  • Masaya Suenaga
    • 1
  • Masamichi Hayashi
    • 1
  • Yukiko Niwa
    • 1
  • Chie Tanaka
    • 1
  • Daisuke Kobayashi
    • 1
  • Goro Nakayama
    • 1
  • Masahiko Koike
    • 1
  • Michitaka Fujiwara
    • 1
  • Tsutomu Fujii
    • 2
  • Yasuhiro Kodera
    • 1
  1. 1.Department of Gastroenterological Surgery (Surgery II)Nagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical SciencesUniversity of ToyamaToyamaJapan

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