Preoperative nutritional status is a useful predictor of the feasibility of postoperative treatment in octogenarian-plus pancreatic ductal adenocarcinoma patients
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引用次数: 0
Abstract
Background
The suitability of radical surgery for very elderly pancreatic cancer (PC) patients remains controversial due to concerns about postoperative functional reserve. Inflammatory-nutritional status may help identify elderly patients at risk of compromised postoperative treatment tolerance.
Methods
This retrospective analysis included 121 patients over eighty who were diagnosed with PC in 2010–2019, 40 of whom underwent radical surgery. Surgical outcomes were compared with those of 205 younger patients (under 80 years-old) who underwent radical surgery. K-means cluster analysis was conducted with four inflammatory-nutritional indices (NLR, PLR, PNI, and mGPS) to define, and the indices using ordinal logistic analysis were evaluated in each cluster to create a formula named ‘nutritional index (NTI)’, which was then used to redefine the clusters. The predictive ability of the NTI was validated in other octogenarians who underwent pancreatectomy for PC between 2020 and 2023.
Results
Patients older than eighty exhibited comparable overall survival to younger patients (median survival time, 30.7/37.1 months, p = 0.20). However, octogenarian-plus patients had lower rates of adjuvant chemotherapy (AC) initiation (45/80 %) and treatment upon recurrence (52/84 %), resulting in shorter survival after recurrence (7.4/11.1 months, p = 0.06). Inflammatory-nutritional status was significantly associated with overall survival, with poor nutritional status being linked to lower rates of AC initiation and/or treatment upon recurrence. NTI effectively predicted AC feasibility.
Conclusions
Radical surgery for octogenarian-plus PC patients meeting the current criteria was safe, but lower rates of postoperative treatment initiation may lead to poorer outcomes after recurrence. Inflammatory-nutritional status assessment could enhance surgical eligibility in octogenarian-plus PC patients.
期刊介绍:
JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery.
The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.