- Email: [email protected]
The prognostic significance of preoperative nutritional status in resected pancreatic ductal adenocarcinoma (PDAC)
abstracts Funding: Fred C and Katherine B Andersen Foundation and the United States National Cancer Institute. Disclosure: All authors have declared no conflicts of interest.
1778P
The prognostic significance of preoperative nutritional status in resected pancreatic ductal adenocarcinoma (PDAC)
Background: Nutritional derangements are common hallmarks of PDAC. Their early detection and management are usually overlooked in routine practice. The aim of this study was to explore the prognostic value of nutritional status in patients (pts) undergoing surgery for PDAC. Methods: We prospectively studied 73 non-consecutive pts submitted to surgery for PDAC from November 2015 to January 2018 at General and Pancreatic Surgery Unit, Pancreas Institute, University Hospital of Verona. Nutritional Risk Screening (NRS) 2002 was used to evaluate the nutritional risk. Body composition was assessed using Bioelectrical Impedance Vector Analysis (BIVA) the day before the scheduled surgery. Clinical, pathological and nutritional data were correlated to disease-free/overall survival (DFS/OS) using a Cox and logistic regression model. Kaplan-Meier curves were compared with Log-Rank. Results: The median age was 65 years [range 37-81], 41 pts were male (56.2%) and 32 were female (43.8%). Median follow-up was 11 months [range 1-40]. The majority (80.8%) were at risk of malnutrition (NRS-20023), despite median BMI was 23.9 kg/ m2. At multivariate analysis, stage (HR 4.30, 95% CI 1.03-17.92, p ¼ 0.045), NRS-2002 (HR 6.51, 95% CI 1.39-30.38, p ¼ 0.017), fat-free mass (FFM) (HR 1.08, 95% CI 1.021.14, p ¼ 0.013) were significant independent predictors for OS. Particularly, pts with preoperative NRS-2002 3 had significantly longer 2-year OS than those with NRS2002 >3 (94% vs 75%, p ¼ 0.02). Twenty-four pts (32.9%) were treated with neoadjuvant therapy. NRS-2002 was significantly higher in this subset of pts (p ¼ 0.026), with a significant difference according to chemotherapy regimens (Folfirinox vs. Gemcitabine/Nab-paclitaxel) (p ¼ 0.035). In pts treated with adjuvant chemotherapy (n ¼ 33, 45.2%) FFM correlated with worse DSF and OS (p ¼ 0.039 and p ¼ 0.039, respectively). Conclusions: Our analysis suggests that preoperative malnutrition has a detrimental impact on OS in PDAC. Therefore, preoperative nutritional screening and, possibly, targeted nutritional intervention may improve outcomes in resectable PDAC pts, particularly in those who are candidate to neoadjuvant therapy. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: M. Milella: Honoraria (self): Pfizer, EUSA Pharma, AstraZeneca. All other authors have declared no conflicts of interest.
1779P
Impact of timing and technique of gastrostomy placement on the outcome of patients (pts) with head and neck cancer (HNC)
os2, G. Vilacampa3, J.D. Assaf1, M.J. Lostes Bardaji1, N.M. Diaz1, A. Hernando1, C. Puiggr os-Atin4, J. Lorente5, J. Giralt6, C. Viaplana3, N. Saudi1, J. Ros1, A. Garcia1, C. Besc M. Biosca1, J. Tabernero7, E. Felip1, R. Dienstmann3, I. Brana1 1 Medical Oncology Service, Vall d’Hebron University Hospital, Barcelona, Spain, 2 Endocrinology and Nutrition, Vall d’Hebron University Hospital, Barcelona, Spain, 3 Oncology Data Science, Vall d’Hebron University Hospital, Barcelona, Spain, 4Oral and Maxillofacial Surgery, Vall d’Hebron University Hospital, Barcelona, Spain, 5 Otorhinolaryngology, Vall d’Hebron University Hospital, Barcelona, Spain, 6Radiation Oncology, Vall d’Hebron University Hospital, Barcelona, Spain, 7Medical Oncology Service, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain Background: Nutritional status affects survival of pts with HNC. Close to half HNC pts require enteral nutrition, with percutaneous endoscopic gastrostomy (PEG) being the preferred route. We studied whether PEG placement technique and timing impact on HNC pts outcomes. Methods: We retrospectively analyzed all HNC pts who underwent PEG insertion between February 2014 and August 2018 at Vall dHebron University Hospital. The primary objectives were to assess overall survival (OS) and PEG complication rate in light of nutritional parameters (albumin, cholesterol and PCR) and disease stage (local and locally-advanced [LA] vs recurrent-metastatic [R/M]) when PEG is placed in a prophylactic (P-PEG) or symptomatic (S-PEG) setting with endoscopic or radiologic intervention.
v726 | Supportive Care
Results: Out of 125 pts, 52% had LA disease and 48% R/M, 37% had P-PEG, 63% SPEG [tumor related symptoms (61%), treatment toxicity (30%), nasogastric tube intolerance or dysfunction (6%), and other feeding disorders (3%)]. High albumin and cholesterol levels associated with better of OS [HR ¼ 0.64 (CI 95% 0.42-0.98), p ¼ 0.04 and HR ¼ 0.65 (CI 95% 0.43-0.99), p ¼ 0.04, respectively]. In the R/M setting, no difference in median OS was observed between P-PEG 18.9 months (m) (CI 95% 12.7-45) and SPEG 15.6 m (CI 95% 11.5-22.2, HR ¼ 0.89, CI 95% 0.57-1.4, p ¼ 0.62). In the LA setting, we found numerically longer median OS in pts with P-PEG 42.2 m (CI 95% 21.9NA) vs PEG-S 16.2 m (CI 95% 11.5-NA, HR ¼ 0.72, CI 95% 0.37-1.94, p ¼ 0.33). Complication rate was 28% in the P-PEG group vs 30% S-PEG group (p ¼ 0.8). Most common complications included infection 35%, ileus and delayed gastric emptying (22%), and bronchial aspiration (13%). Complications led to treatment interruption in 4 pts (3.2%). Complication rate was lower in LA setting than in R/M setting (24% vs 35%, p ¼ 0.2). Endoscopic PEG placement was associated with less complications (9%) than radiologic placement (47%, p ¼ 0.08). Conclusions: We confirmed that nutritional parameters impact on HNC pts OS. In the LA setting, P-PEG might be associated with a better outcome. Endoscopic PEG placement appears to be related to fewer complications. Our results will help design a PEG placement algorithm to further evaluate the role of P-PEG. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: J. Tabernero: Advisory / Consultancy: Arrays Biopharma; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Bayer; Advisory / Consultancy: BeiGene; Advisory / Consultancy: Boehringer Ingelheim; Advisory / Consultancy: Chugai; Advisory / Consultancy: Genentech; Advisory / Consultancy: Inc; Advisory / Consultancy: Genmab A/S; Advisory / Consultancy: Halozyme; Advisory / Consultancy: Imugene Limited; Advisory / Consultancy: Inflection Biosciences Limited; Advisory / Consultancy: Ipsen; Advisory / Consultancy: Kura Oncology; Advisory / Consultancy: Lilly; Advisory / Consultancy: MSD; Advisory / Consultancy: Menarini; Advisory / Consultancy: Merrimack; Advisory / Consultancy: Merus; Advisory / Consultancy: Molecular Partners, Novartis, Peptomyc, Pfizer, Pharmacyclics, ProteoDesign SL, Rafael Pharmaceuticals, F. Hoffmann-La Roche Ltd, Sanofi, SeaGen, Seattle Genetics, Servier, Symphogen, Taiho, VCN Biosciences, Biocartis, Foundation Medicine, HalioDX SAS. E. Felip: Advisory / Consultancy: AbbVie, AstraZeneca, Blue Print Medicines, Boehringer Ingelheim, BMS, Celgene, Eli Lilly, Guardant Health, Merck KGaA, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Takeda, Janssen; Speaker Bureau / Expert testimony: AbbVie, AstraZeneca, Boehringer Ingelheim, BMS, Eli Lilly, Merck KGaA, Merck sharp & dohme, Novartis, Pfizer, Roche, Takeda.; Research grant / Funding (self): Fundaci on Merck Salud Grant for Oncology Innovation. R. Dienstmann: Advisory / Consultancy: Roche ; Speaker Bureau / Expert testimony: Roche, Symphogen, Ipsen, Amgen, Sanofi, MSD, Servier; Research grant / Funding (self): Merck. All other authors have declared no conflicts of interest.
1780P
Clinical & nutritional determinants of quality of life in patients with incurable cancer
L.E. Daly1, E.S. Sullivan1, R. Dolan2, E.B. Nı Bhuachalla1, S.J. Cushen1, M. Fallon3, C. Simmons3, D.C. McMillan2, B. Laird3, A.M. Ryan1, D.G. Power4 1 School of Nutritional Sciences, University College Cork, Cork, Ireland, 2Academic Unit of Surgery, University of Glasgow, Glasgow, UK, 3Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK, 4Departments of Medical Oncology, Cork & Mercy University Hospitals, Cork, Ireland Background: Optimising quality of life (QoL) remains the central tenet of care in patients with incurable cancer, however determinants of this are not clear. Methods: Multi-centre study conducted across 18 sites in Ireland and United Kingdom over a period of 5 years (2011-2016). Data collected included: patient demographics, Performance Status (ECOG-PS), weight loss (%WL) and skeletal muscle index (SMI) and skeletal muscle attenuation (MA) assessed by CT images, inflammatory markers [modified Glasgow Prognostic score (mGPS)] and QoL data (EORTC QLQ-30). The relationship between clinical and nutritional parameters with QoL was assessed using the Spearman rank correlation coefficient & multivariate binary logistic regression. Results: Data were available on 1027 patients, of which 51% were male and the median age was 66 (IQR 57-74) years. Gastrointestinal cancer was most prevalent (40%) and 87% of patients had metastatic disease. %WL, ECOG-PS and mGPS were significantly correlated with deteriorating QoL functional & symptom scales (all p < 0.001). On multivariate regression analysis, >10% WL (OR 2.69 [95% CI: 1.63-4.42]), ECOG-PS 3-4 (OR 14.33 [95% CI: 6.76- 30.37]) and mGPS score 2 (OR 1.58 [95% CI: 1.092.29]) were independently associated with poorer summary QoL score. WL & mGPS were also independently associated with poor physical function, fatigue and appetite loss (all p < 0.05). Low MA was independently associated with poor physical function (OR 1.67 [95% CI: 1.09-2.56]), but not with fatigue, appetite or QoL summary score. Conclusions: The findings indicate that QoL is determined in part by WL, ECOG-PS and systemic inflammation in patients with advanced cancer. Although muscle parameters were associated with some QoL domains, no significant independent association with fatigue, appetite loss or QoL summary score was observed. Identifying early predictors of poor QoL may allow the identification of patients who may benefit from early referral to palliative care, which has been shown to improve QoL. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz265.024/5577389 by guest on 26 October 2019
S. Paiella1, I. Trestini2, I. Sperduti3, M. Sandini4, G. Elio1, D. Melisi2, A. Auriemma2, C. Solda2, D. Tregnago2, A. Avancini5, E. Secchettin1, D. Bonamini1, G. Malleo1, L. Gianotti4, S. Pilotto2, C. Bassi1, M. Milella2 1 General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy, 2Department of Oncology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy, 3Biostatistical Unit - Clinical Trials Center, Bio-Statistics Unit, Regina Elena National Cancer Institute, Rome, Italy, 4Department of Surgery, School of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy, 5Biomedical Sciences, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
Annals of Oncology
1778P
The prognostic significance of preoperative nutritional status in resected pancreatic ductal adenocarcinoma (PDAC)
Background: Nutritional derangements are common hallmarks of PDAC. Their early detection and management are usually overlooked in routine practice. The aim of this study was to explore the prognostic value of nutritional status in patients (pts) undergoing surgery for PDAC. Methods: We prospectively studied 73 non-consecutive pts submitted to surgery for PDAC from November 2015 to January 2018 at General and Pancreatic Surgery Unit, Pancreas Institute, University Hospital of Verona. Nutritional Risk Screening (NRS) 2002 was used to evaluate the nutritional risk. Body composition was assessed using Bioelectrical Impedance Vector Analysis (BIVA) the day before the scheduled surgery. Clinical, pathological and nutritional data were correlated to disease-free/overall survival (DFS/OS) using a Cox and logistic regression model. Kaplan-Meier curves were compared with Log-Rank. Results: The median age was 65 years [range 37-81], 41 pts were male (56.2%) and 32 were female (43.8%). Median follow-up was 11 months [range 1-40]. The majority (80.8%) were at risk of malnutrition (NRS-20023), despite median BMI was 23.9 kg/ m2. At multivariate analysis, stage (HR 4.30, 95% CI 1.03-17.92, p ¼ 0.045), NRS-2002 (HR 6.51, 95% CI 1.39-30.38, p ¼ 0.017), fat-free mass (FFM) (HR 1.08, 95% CI 1.021.14, p ¼ 0.013) were significant independent predictors for OS. Particularly, pts with preoperative NRS-2002 3 had significantly longer 2-year OS than those with NRS2002 >3 (94% vs 75%, p ¼ 0.02). Twenty-four pts (32.9%) were treated with neoadjuvant therapy. NRS-2002 was significantly higher in this subset of pts (p ¼ 0.026), with a significant difference according to chemotherapy regimens (Folfirinox vs. Gemcitabine/Nab-paclitaxel) (p ¼ 0.035). In pts treated with adjuvant chemotherapy (n ¼ 33, 45.2%) FFM correlated with worse DSF and OS (p ¼ 0.039 and p ¼ 0.039, respectively). Conclusions: Our analysis suggests that preoperative malnutrition has a detrimental impact on OS in PDAC. Therefore, preoperative nutritional screening and, possibly, targeted nutritional intervention may improve outcomes in resectable PDAC pts, particularly in those who are candidate to neoadjuvant therapy. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: M. Milella: Honoraria (self): Pfizer, EUSA Pharma, AstraZeneca. All other authors have declared no conflicts of interest.
1779P
Impact of timing and technique of gastrostomy placement on the outcome of patients (pts) with head and neck cancer (HNC)
os2, G. Vilacampa3, J.D. Assaf1, M.J. Lostes Bardaji1, N.M. Diaz1, A. Hernando1, C. Puiggr os-Atin4, J. Lorente5, J. Giralt6, C. Viaplana3, N. Saudi1, J. Ros1, A. Garcia1, C. Besc M. Biosca1, J. Tabernero7, E. Felip1, R. Dienstmann3, I. Brana1 1 Medical Oncology Service, Vall d’Hebron University Hospital, Barcelona, Spain, 2 Endocrinology and Nutrition, Vall d’Hebron University Hospital, Barcelona, Spain, 3 Oncology Data Science, Vall d’Hebron University Hospital, Barcelona, Spain, 4Oral and Maxillofacial Surgery, Vall d’Hebron University Hospital, Barcelona, Spain, 5 Otorhinolaryngology, Vall d’Hebron University Hospital, Barcelona, Spain, 6Radiation Oncology, Vall d’Hebron University Hospital, Barcelona, Spain, 7Medical Oncology Service, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain Background: Nutritional status affects survival of pts with HNC. Close to half HNC pts require enteral nutrition, with percutaneous endoscopic gastrostomy (PEG) being the preferred route. We studied whether PEG placement technique and timing impact on HNC pts outcomes. Methods: We retrospectively analyzed all HNC pts who underwent PEG insertion between February 2014 and August 2018 at Vall dHebron University Hospital. The primary objectives were to assess overall survival (OS) and PEG complication rate in light of nutritional parameters (albumin, cholesterol and PCR) and disease stage (local and locally-advanced [LA] vs recurrent-metastatic [R/M]) when PEG is placed in a prophylactic (P-PEG) or symptomatic (S-PEG) setting with endoscopic or radiologic intervention.
v726 | Supportive Care
Results: Out of 125 pts, 52% had LA disease and 48% R/M, 37% had P-PEG, 63% SPEG [tumor related symptoms (61%), treatment toxicity (30%), nasogastric tube intolerance or dysfunction (6%), and other feeding disorders (3%)]. High albumin and cholesterol levels associated with better of OS [HR ¼ 0.64 (CI 95% 0.42-0.98), p ¼ 0.04 and HR ¼ 0.65 (CI 95% 0.43-0.99), p ¼ 0.04, respectively]. In the R/M setting, no difference in median OS was observed between P-PEG 18.9 months (m) (CI 95% 12.7-45) and SPEG 15.6 m (CI 95% 11.5-22.2, HR ¼ 0.89, CI 95% 0.57-1.4, p ¼ 0.62). In the LA setting, we found numerically longer median OS in pts with P-PEG 42.2 m (CI 95% 21.9NA) vs PEG-S 16.2 m (CI 95% 11.5-NA, HR ¼ 0.72, CI 95% 0.37-1.94, p ¼ 0.33). Complication rate was 28% in the P-PEG group vs 30% S-PEG group (p ¼ 0.8). Most common complications included infection 35%, ileus and delayed gastric emptying (22%), and bronchial aspiration (13%). Complications led to treatment interruption in 4 pts (3.2%). Complication rate was lower in LA setting than in R/M setting (24% vs 35%, p ¼ 0.2). Endoscopic PEG placement was associated with less complications (9%) than radiologic placement (47%, p ¼ 0.08). Conclusions: We confirmed that nutritional parameters impact on HNC pts OS. In the LA setting, P-PEG might be associated with a better outcome. Endoscopic PEG placement appears to be related to fewer complications. Our results will help design a PEG placement algorithm to further evaluate the role of P-PEG. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: J. Tabernero: Advisory / Consultancy: Arrays Biopharma; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Bayer; Advisory / Consultancy: BeiGene; Advisory / Consultancy: Boehringer Ingelheim; Advisory / Consultancy: Chugai; Advisory / Consultancy: Genentech; Advisory / Consultancy: Inc; Advisory / Consultancy: Genmab A/S; Advisory / Consultancy: Halozyme; Advisory / Consultancy: Imugene Limited; Advisory / Consultancy: Inflection Biosciences Limited; Advisory / Consultancy: Ipsen; Advisory / Consultancy: Kura Oncology; Advisory / Consultancy: Lilly; Advisory / Consultancy: MSD; Advisory / Consultancy: Menarini; Advisory / Consultancy: Merrimack; Advisory / Consultancy: Merus; Advisory / Consultancy: Molecular Partners, Novartis, Peptomyc, Pfizer, Pharmacyclics, ProteoDesign SL, Rafael Pharmaceuticals, F. Hoffmann-La Roche Ltd, Sanofi, SeaGen, Seattle Genetics, Servier, Symphogen, Taiho, VCN Biosciences, Biocartis, Foundation Medicine, HalioDX SAS. E. Felip: Advisory / Consultancy: AbbVie, AstraZeneca, Blue Print Medicines, Boehringer Ingelheim, BMS, Celgene, Eli Lilly, Guardant Health, Merck KGaA, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Takeda, Janssen; Speaker Bureau / Expert testimony: AbbVie, AstraZeneca, Boehringer Ingelheim, BMS, Eli Lilly, Merck KGaA, Merck sharp & dohme, Novartis, Pfizer, Roche, Takeda.; Research grant / Funding (self): Fundaci on Merck Salud Grant for Oncology Innovation. R. Dienstmann: Advisory / Consultancy: Roche ; Speaker Bureau / Expert testimony: Roche, Symphogen, Ipsen, Amgen, Sanofi, MSD, Servier; Research grant / Funding (self): Merck. All other authors have declared no conflicts of interest.
1780P
Clinical & nutritional determinants of quality of life in patients with incurable cancer
L.E. Daly1, E.S. Sullivan1, R. Dolan2, E.B. Nı Bhuachalla1, S.J. Cushen1, M. Fallon3, C. Simmons3, D.C. McMillan2, B. Laird3, A.M. Ryan1, D.G. Power4 1 School of Nutritional Sciences, University College Cork, Cork, Ireland, 2Academic Unit of Surgery, University of Glasgow, Glasgow, UK, 3Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK, 4Departments of Medical Oncology, Cork & Mercy University Hospitals, Cork, Ireland Background: Optimising quality of life (QoL) remains the central tenet of care in patients with incurable cancer, however determinants of this are not clear. Methods: Multi-centre study conducted across 18 sites in Ireland and United Kingdom over a period of 5 years (2011-2016). Data collected included: patient demographics, Performance Status (ECOG-PS), weight loss (%WL) and skeletal muscle index (SMI) and skeletal muscle attenuation (MA) assessed by CT images, inflammatory markers [modified Glasgow Prognostic score (mGPS)] and QoL data (EORTC QLQ-30). The relationship between clinical and nutritional parameters with QoL was assessed using the Spearman rank correlation coefficient & multivariate binary logistic regression. Results: Data were available on 1027 patients, of which 51% were male and the median age was 66 (IQR 57-74) years. Gastrointestinal cancer was most prevalent (40%) and 87% of patients had metastatic disease. %WL, ECOG-PS and mGPS were significantly correlated with deteriorating QoL functional & symptom scales (all p < 0.001). On multivariate regression analysis, >10% WL (OR 2.69 [95% CI: 1.63-4.42]), ECOG-PS 3-4 (OR 14.33 [95% CI: 6.76- 30.37]) and mGPS score 2 (OR 1.58 [95% CI: 1.092.29]) were independently associated with poorer summary QoL score. WL & mGPS were also independently associated with poor physical function, fatigue and appetite loss (all p < 0.05). Low MA was independently associated with poor physical function (OR 1.67 [95% CI: 1.09-2.56]), but not with fatigue, appetite or QoL summary score. Conclusions: The findings indicate that QoL is determined in part by WL, ECOG-PS and systemic inflammation in patients with advanced cancer. Although muscle parameters were associated with some QoL domains, no significant independent association with fatigue, appetite loss or QoL summary score was observed. Identifying early predictors of poor QoL may allow the identification of patients who may benefit from early referral to palliative care, which has been shown to improve QoL. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz265.024/5577389 by guest on 26 October 2019
S. Paiella1, I. Trestini2, I. Sperduti3, M. Sandini4, G. Elio1, D. Melisi2, A. Auriemma2, C. Solda2, D. Tregnago2, A. Avancini5, E. Secchettin1, D. Bonamini1, G. Malleo1, L. Gianotti4, S. Pilotto2, C. Bassi1, M. Milella2 1 General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy, 2Department of Oncology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy, 3Biostatistical Unit - Clinical Trials Center, Bio-Statistics Unit, Regina Elena National Cancer Institute, Rome, Italy, 4Department of Surgery, School of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy, 5Biomedical Sciences, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
Annals of Oncology