体重减轻作为胰腺和壶腹周围癌的未开发早期检测标志物。
Weight Loss as an Untapped Early Detection Marker in Pancreatic and Periampullary Cancer.
机构信息
Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Atrium Health, Charlotte, NC, USA.
出版信息
Ann Surg Oncol. 2021 Oct;28(11):6283-6292. doi: 10.1245/s10434-021-09861-8. Epub 2021 Apr 9.
BACKGROUND
Pancreatic ductal adenocarcinoma (PDAC) has the worst survival of common cancers, partly because there are no reliable early detection tests. Unintentional weight loss (≥ 5% decrease from baseline) has been linked to PDAC, but the frequency and severity of weight loss using objective measures, and its relationship to prognosis, have not been well characterized.
METHODS
We identified 390 patients with PDAC (all stages) and two or more prediagnosis weights in the electronic medical record. Percentage weight loss in the 365 and 180 days preceding diagnosis was calculated. Results were compared with raw weights of age- and sex-matched non-cancer controls (n = 780). Odds ratios for PDAC were calculated using conditional logistic regression. Cox proportional hazards models were used for survival.
RESULTS
Within 1 year of diagnosis, more PDAC patients lost ≥ 5% weight relative to controls (74.9% vs. 11.2%; p < 0.001), with a median weight loss of 14.2 versus 2.9 lbs. The odds ratio for PDAC comparing weight loss within 1 year of 5 to < 10% was 10.30 (p < 0.001) and 77.82 for ≥ 10% (p < 0.001), compared with stable weight. Weight loss prior to diagnosis was also associated with early-stage PDAC. PDAC cases with ≥ 10% prediagnosis weight loss had worse survival compared with stable weights (hazard ratio [HR] 1.60; p = 0.01). Greater prediagnosis weight loss was associated with poor survival after pancreatectomy (5 to < 10% vs. < 5%, HR 2.40, p = 0.03; ≥ 10% vs. < 5%, HR 2.59, p = 0.03).
CONCLUSIONS
Diagnosis of PDAC is preceded by unintentional weight loss in the majority of patients, even at an early stage. Greater prediagnosis weight loss severity is also associated with poor postoperative survival.
背景
胰腺导管腺癌（PDAC）的存活率是所有常见癌症中最差的，部分原因是缺乏可靠的早期检测手段。体重意外下降（与基线相比下降≥5%）与 PDAC 相关，但使用客观指标衡量体重下降的频率和严重程度及其与预后的关系尚未得到很好的描述。
方法
我们在电子病历中确定了 390 名患有 PDAC（所有阶段）和两个或多个诊断前体重的患者。计算诊断前 365 天和 180 天内的体重百分比下降。将结果与年龄和性别匹配的非癌症对照组（n=780）的原始体重进行比较。使用条件逻辑回归计算 PDAC 的优势比。使用 Cox 比例风险模型进行生存分析。
结果
在诊断后 1 年内，与对照组相比，更多的 PDAC 患者体重下降≥5%（74.9% vs. 11.2%；p<0.001），体重中位数下降 14.2 磅和 2.9 磅。在 1 年内体重下降 5%至<10%的 PDAC 比值比为 10.30（p<0.001），体重下降≥10%的比值比为 77.82（p<0.001），与体重稳定相比。诊断前的体重下降也与早期 PDAC 有关。与体重稳定相比，有≥10%的预诊断体重下降的 PDAC 病例的生存情况更差（风险比 [HR] 1.60；p=0.01）。较大的预诊断体重下降与胰腺切除术后的不良生存相关（5%至<10%与<5%，HR 2.40，p=0.03；≥10%与<5%，HR 2.59，p=0.03）。
结论
大多数 PDAC 患者在诊断前就出现了意外的体重下降，即使在早期阶段也是如此。更大的预诊断体重下降严重程度也与术后生存不良相关。
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