Cachexia is an Insidious Symptom of Pancreatic Ductal Adenocarcinoma Associated with Delayed Diagnosis and Advanced Stage of Disease

Matteo Piciucchi; Roberto Valente; Serena Stigliano; Livia Archibugi; Giulia Zerboni; Marianna Signoretti; Alberto Larghi; Guido Costamagna; Gianfranco Delle Fave; Gabriele Capurso

doi:10.6092/1590-8577/1756

Matteo Piciucchi Digestive and Liver Disease, Sant’Andrea Hospital of Rome, “Sapienza” University of Rome. Rome. Italy
Roberto Valente Digestive and Liver Disease, Sant’Andrea Hospital of Rome, “Sapienza” University of Rome. Rome. Italy
Serena Stigliano Digestive and Liver Disease, Sant’Andrea Hospital of Rome, “Sapienza” University of Rome. Rome. Italy
Livia Archibugi Digestive and Liver Disease, Sant’Andrea Hospital of Rome, “Sapienza” University of Rome. Rome. Italy
Giulia Zerboni Digestive and Liver Disease, Sant’Andrea Hospital of Rome, “Sapienza” University of Rome. Rome. Italy
Marianna Signoretti Digestive and Liver Disease, Sant’Andrea Hospital of Rome, “Sapienza” University of Rome. Rome. Italy
Alberto Larghi Endoscopic Unit, Catholic University of Rome. Rome. Italy
Guido Costamagna Endoscopic Unit, Catholic University of Rome. Rome. Italy
Gianfranco Delle Fave Digestive and Liver Disease, Sant’Andrea Hospital of Rome, “Sapienza” University of Rome. Rome. Italy
Gabriele Capurso Digestive and Liver Disease, Sant’Andrea Hospital of Rome, “Sapienza” University of Rome. Rome. Italy

DOI: https://doi.org/10.6092/1590-8577/1756

Keywords: Meeting Abstracts, Pancreas

Abstract

Context Pancreatic ductal adenocarcinoma (PDAC) is an aggressive neoplasm, frequently presenting with cachexia that seems to retard the diagnosis and leading to worse prognosis. Molecular mechanism of cachexia are increasing explained, but its clinical features and its impacts on prognosis are still unclear. Objective To evaluate prevalence and features of a cachexia as presenting symptom of PDAC, clinical factors associated to its occurrence and its associated survival in PDAC patients. Methods Database retrospective analysis of prospective enrolled PDAC (Jan 2006 to Jan 2012): symptoms, tumor’s features and outcome of patients with cachexia (defined as weight loss >5 kg in the year before diagnosis) compared to those without it. Results Two-hundred and 91 PDAC patients enrolled: 144 (49.4%) presented cachexia (C+). C+ patients had similar medical history (chronic pancreatitis, diabetes, insulin and statin usage) than C-, but they were more frequently male (61.0% C+ vs. 46.5% C-; P=0.04) and overweight subjects (mean BMI: 28.6 kg/m² C+ vs. 25.9 kg/m² C-; P=0.0001). The onset symptoms other than cachexia were similarly frequent in C- and C+ patients, but for unspecific abdominal pain which was more frequent in C+ (56.4 %) than C- (40.8%; P=0.004). Patients with cachexia had a longer diagnostic delay than C- (4.81 months vs. 2.23 P=0001). C+ and C- patients had similar site and size of primary tumor, as well as histological grading, but C+ had more frequently distant metastasis at diagnosis (44.4% C+ vs. 32.6% C-; P=0.04) and a shorter, although non significantly, overall survival (7 vs. 11 months; P=0.19) compared to C-. Conclusion In our cohort of incident PDAC, about half of patients presented with cachexia. Cachexia was frequently associated with abdominal pain and with a diagnostic delay, and with a metastatic stage at diagnosis. The results suggest that unexplained weight loss and recurrent abdominal pain are under-evaluated symptoms of PDAC, and their investigation might lead to an earlier diagnosis of this aggressive disease.

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