Association between early nutritional risk and overall survival in patients with advanced pancreatic cancer: A single-center retrospective study

Background & aims: We investigated the predictors of overall survival (OS) among Korean patients with advanced pancreatic cancer (PC) according to their baseline nutritional status. Methods: We retrospectively reviewed the data of 412 inpatients with PC between January 2007 and February 2015 at the Department of Oncology of the Gangnam Severance Hospital, Korea. Data on demographic and clinical parameters were collected from electronic medical records, and OS was estimated using the Kaplan-Meier method. Stepwise Cox regression analysis was used to determine the factors associated with survival. Patients with a Nutritional Risk Screening (NRS) 2002 score <3 were classified as no-risk; those with a score of 3 were classified as moderate-risk; and those with a score of >= 4 were classified as high-risk. Results: Following nutritional screening at baseline, 194 patients (47.1%, mean age 61.8 +/- 9.9 years) were classified as the no risk group; 81 patients (19.7%, mean age 65.4 +/- 10.8 years), as the moderate risk group; and 137 patients (33.3%, mean age 67.8 +/- 12.0 years), as the high risk group. Predictors of survival were NRS 2002 score (hazard ratio [HR] = 1.238; 95% confidence interval [CI] = 1.143-1.341), percentage of lymphocytes (HR = 0.973; 95% CI = 0.962-0.984), C-reactive protein level (HR = 1.003; 95% CI = 1.001-1.006), carcinoembryonic antigen level (HR = 1.000; 95% CI = 1.000-1.000), and carbohydrate antigen 19-9 level (HR = 1.000; 95% CI = 1.000-1.000). Kaplan-Meier survival analysis showed significant differences in the median OS among the NRS 2002 groups: no risk group: 12.3 +/- 0.4 months (95% CI: 11.47-13.13 months); moderate risk group: 6.5 +/- 0.9 months (95% CI: 4.78-8.17 months); and high risk group: 5.5 +/- 0.6 months (95% CI: 4.31-6.69 months). Conclusions: A good baseline nutritional status was associated with OS among Korean patients with advanced PC. An improvement in the nutritional status of patients with advanced PC through baseline nutritional interventions is therefore necessary to prolong OS. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism.