Pancreatic cancerrelated cachexia: influence on metabolism and correlation to weight loss and pulmonary function

<p>Abstract</p> <p>Background</p> <p>Dramatic weight loss is an often underestimated symptom in pancreatic cancer patients. Cachexia- defined as an unintended loss of stable weight exceeding 10% – is present in up to 80% of patients with cancer of the upper gastrointestinal tract, and has a significant influence on survival. The aim of the study was to show the multiple systemic effects of cachexia in pancreatic cancer patients, in terms of resection rate, effects on pulmonary function, amount of fat and muscle tissue, as well as changes in laboratory parameters.</p> <p>Methods</p> <p>In patients with pancreatic cancer, clinical appearance was documented, including the amount of weight loss. Laboratory parameters and lung-function tests were evaluated, and the thickness of muscle and fat tissue was measured with computed tomography scans. Statistical analysis, including multivariate analysis, was performed using SPSS software. Survival curves were calculated using Kaplan-Meier analysis and the log-rank test. To test for significant differences between the examined groups we used Student's t-test and the Mann-Whitney U test. Significance was defined as p < 0.05.</p> <p>Results</p> <p>Of 198 patients with a ductal adenocarcinoma of the pancreas, 70% were suffering from weight loss when they presented for operation, and in 40% weight loss exceeded 10% of the stable weight. In patients with cachexia, metastases were diagnosed significantly more often (47% vs. 24%, P < 0.001), leading to a significantly reduced resection rate in these patients. Patients with cachexia had significantly reduced fat tissue amounts. Hence, dramatic weight loss in a patient with pancreatic cancer may be a hint of a more progressed or more aggressive tumour.</p> <p>Conclusion</p> <p>Pancreatic cancer patients with cachexia had a higher rate of more progressed tumour stages and a worse nutritional status. Furthermore, patients with cachexia had an impaired lung function and a reduction in fat tissue. Patients with pancreatic cancer and cachexia had significantly reduced survival. If weight loss exceeded 5% there was a significantly reduced resection rate to detect, but the changes were significantly more substantial if weight loss was 10% or more. We propose that a weight loss of 10% be defined as significant in pancreatic cancer.</p

Cytogenetic Abnormalities and Appearance of Multiple Myeloma in Whole Body-MRI.

Abstract Abstract 4868 Introduction In magnetic resonance imaging (MRI) multiple myeloma (MM) presents with circumscribed focal lesions or diffuse infiltration of bone marrow. To identify genetic mechanisms influencing the growth pattern, whole-body MRI of 99 patients with asymptomatic and 114 patients with symptomatic MM were evaluated retrospectively by two experienced radiologists. The pattern was analyzed in the spine and focal lesions were counted in the whole body differentiating intra-osseous and soft tissue lesions as well as osseus tumors affecting cortical bone. Cytogenetic analysis was performed using interphase fluorescence in-situ hybridization (iFISH) on CD138-purified monoclonal plasma cells acquired by unilateral bone marrow aspiration for the following aberrations: t(4;14), t(11;14), t(14;16), deletions 13q14 and 17p13, as well as gain of 1q21. Statistical analysis was performed to address the following questions: i) Is there a significant correlation of chromosomal abnormalities with the presentation of MM in MRI ii) Is there an association of the occurrence of affection of cortical bone with cytogenetic aberrations. As a number of more than 7 focal lesions in the axial skeleton has been shown to be an adverse prognostic factor for patients with symptomatic MM, we performed a search for an optimal cut-off point in number of focal lesions in whole body MRI with respect to progression free survival and overall survival. As event for progression free survival initiation of treatment for asymptomatic MM and progression after the first line of treatment for symptomatic MM was defined. Results Correlation of the presentation of MM in MRI with common chromosomal abnormalities was found neither concerning focal or diffuse infiltration patterns nor an affection of cortical bone, potentially leading to instability. A search for the optimal cut-off point led to a number of more than one and more than 8 focal lesions in whole body MRI for asymptomatic and symptomatic MM respectively. The only significant prognostic factors for progression of asymptomatic MM into symptomatic disease were the presence per se and a number of more than one focal lesion or diffuse infiltration in MRI. For symptomatic myeloma a number of more than 8 focal lesions was the only significant prognostic factor for overall survival (HR 4.87; p-value &lt;0.001). In symptomatic disease the factors t(4;14), gain of 1q21 and a diffuse infiltration pattern (for overall survival) and gain of 1q21 (for progression free survival) lost statistical significance after adjustment of p-values because of multiple testing. Conclusion In our cohort of 213 patients the most important risk factors for overall survival were focal lesions above a cut-off point of 1 and 8 for asymptomatic and symptomatic MM, respectively. No correlation of the appearance of MM in MRI with the presence of cytogenetic abnormalities in iFISH analysis was found. We therefore conclude that the infiltration pattern in MRI is not associated with cytogenetic abnormalities and that the number of focal lesions in whole body MRI is an important and independent risk factor for patients with multiple myeloma. Disclosures No relevant conflicts of interest to declare. </jats:sec

Prognostic Significance of Focal Lesions in Whole-Body Magnetic Resonance Imaging in Patients With Asymptomatic Multiple Myeloma

Purpose With whole-body magnetic resonance imaging (wb-MRI), almost the whole bone marrow compartment can be examined in patients with monoclonal plasma cell disease. Focal lesions (FLs) detected by spinal MRI have been of prognostic significance in symptomatic multiple myeloma (sMM). In this study, we investigated the prognostic significance of FLs in wb-MRI in patients with asymptomatic multiple myeloma (aMM). Patients and Methods Wb-MRI was performed in 149 patients with aMM. The prognostic significance of the presence and absence, as well as the number, of FLs for progression into sMM was analyzed. Results FLs were present in 28% of patients. The presence per se of FLs and a number of greater than one FL were the strongest adverse prognostic factors for progression into sMM (P &lt; .001) in multivariate analysis. A diffuse infiltration pattern in MRI, a monoclonal protein of 40 g/L or greater, and a plasma cell infiltration in bone marrow of 20% or greater were other adverse prognostic factors for progression-free survival in univariate analysis. Conclusion We recommend use of wb-MRI for risk stratification of patients with asymptomatic multiple myeloma. </jats:sec