Pancreatic Cancer AssociatedCachexia: Role of the Modified Glasgow Prognostic Score in Outcome Prediction

Cancer-associated-cachexia (CAC) is a ubiquitous characteristic of pancreatic cancer (PC) and 1/3 of patients die from its complications. Systemic inflammation is key in CAC and the modified Glasgow Prognostic Score (mGPS) is a reliable inflammation-based prognostic tool. We aimed to evaluate the prognostic value of consensus-based cachexia classification and mGPS, their agreement and to analyze relevant clinical predictors of cachexia. This unicentric, retrospective, cohort study included patients with advanced PC treated over a 5-year period. Cachexia was classified according to weight loss, body mass index and mGPS. Fisher’s test was used to test correlation between classifications and logistic regression models were performed to test their association with other variables. Survival was analyzed with cox regression and Kaplan-Meier curves. 88 eligible patients (mean age 72, 56% female) were reviewed. At baseline, cachectic patients (CP) (77%), when compared with pre-CP, had worse performance status (p=0.016), more NLR>3,5 (p<0.01) and hypoalbuminemia (p 0.01). Of 77% (n=68) categorized as cachectic, only 16% (n=8) had a positive mGPS. No association was found between classifications (p=0.187). In multivariate analysis, NLR>3.5 was a significant predictor of both cachexia (p<0.001) and positive mGPS (p<0.01). Median overall survival (OS) for pre-CP was 19.1 months vs. 4.9 months in the CP (HR 1.94 95% CI 1.10-3.43 p=0.02). A positive mGPS at baseline was an independent predictor of worst OS (HR 2.73, 95% CI 1.126.66, p=0.027). CAC leads to worst survival and a better understanding of this syndrome in PC may improve outcomes for these patients. Our study suggests a baseline predominant fat-only loss phenotype, that patients with positive mGPS are at higher risk of worst outcomes and that NLR is a potential predictor of CAC. A prompt identification of prognostic markers may lead to a better standardized management of CAC