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.
背景：胰腺导管腺癌（PDAC）仍是一种复杂且具有破坏性的疾病。恶病质症状常影响患者生存期。这一伴随综合征通常在临床症状明显时才被诊断，往往发现较晚。使用传统测量方法进行早期诊断常存在困难，且难以区分该疾病与癌症进展，两者常相互重叠。本研究旨在分析传统营养评估与实验室生物标志物中，哪种能更有效地早期预测生存期缩短风险的患者。 方法：我们分析了一个前瞻性预定义队列，包括182例胃肠道癌症患者，其中120例为PDAC患者，62例为其他胃肠道腺癌（oAC）患者作为对照组。所有患者均具备方案规定的完整传统营养评估数据、临床资料及特定实验室参数。 结果：在肿瘤诊断时，高炎症生物标志物（C反应蛋白（CRP）、白细胞介素-6（IL-6））和低白蛋白血清水平与PDAC患者总生存期（OS）缩短相关，但在oAC患者中未发现此关联。血红蛋白、体重指数（BMI）及生物电阻抗评估单独在诊断时均无预后预测价值。多变量分析显示，仅CRP（HR 1.91（1.25–2.92），p=0.003）是PDAC患者的独立预后因素。在PDAC病程中，炎症生物标志物、白蛋白、血红蛋白及生物电阻抗评估均与OS缩短相关。多变量检验表明，CRP（HR 2.21（1.38–3.55），p<0.001）和白蛋白（HR 1.71（1.05–2.77），p=0.030）是PDAC患者的独立预后因素。 结论：特别对于PDAC患者，高炎症指标和低白蛋白血清水平可能比复杂的传统方法更能有效作为早期替代标志物，用于识别OS缩短高风险患者。这些发现有助于筛选可能受益于早期治疗干预的患者群体。
肿瘤(癌症)患者之家