e16354 Background: Many individuals with pancreatic ductal adenocarcinoma (PDAC) do not receive treatment or enroll in clinical trials, and there is limited literature to guide treatment selection. Given the association between cancer cachexia and poor outcomes, we evaluated whether the University of Texas (UT) Cancer Cachexia Staging System (CCSS) or other clinical variables could predict receipt of treatment and overall survival in PDAC patients. Methods: We conducted a retrospective cohort study of 66 adults diagnosed with PDAC at a single tertiary care center from 2022–2024. Patients were categorized by receipt of systemic therapy. Clinical, demographic, and disease-related variables were compared between treated and untreated groups. UT CCSS scores were calculated for all patients. Descriptive statistics were summarized using medians, interquartile ranges, and percentages. Group comparisons used Fisher’s exact test (p < 0.05), and OS was analyzed using a Cox proportional hazards model. All statistical analyses were conducted using GraphPad Prism version 10.2.2. Results: Overall, 50 patients (75%) received systemic chemotherapy and 16 (25%) did not. Among untreated patients, UT CCSS stages were I (n = 3), II (n = 9), and III (n = 4), compared with stage I (n = 20), II (n = 27), and III (n = 3) among treated patients. Median CA 19-9 levels were 175 (range 5–47,242) in the untreated group and 216 (range 3–574,876) in the treated group. Patients receiving chemotherapy more frequently had advanced TNM stage (III/IV) and higher UT CCSS stage (II/III), while lower TNM stage (I/II) was more common among patients with UT CCSS stage I. Metastatic presentation was 62.5% in the untreated group versus 34% in the treated group. The treated group had a higher percentage (88%) of weight loss. Survival analysis comparing UT CCSS stage I versus II/III demonstrated improved survival in stage I patients, with 85% alive versus 73% at a median follow-up of 10.9 and 11.7 months, respectively (hazard ratio 0.52, 95% CI 0.16–1.73). Conclusions: Among patients with PDAC receiving systemic therapy, advanced cachexia (UT CCSS stage II/III) was associated with worse survival compared with stage I. Use of the UT CCSS may help guide selection of patients for chemotherapy versus best supportive care. Study limitations include a small number of untreated patients and limited follow-up. Prospective validation of the UT CCSS in PDAC treatment decision-making is warranted.
Sargent et al. (Thu,) studied this question.