Investigation of prognostic factors in patients with terminal pancreatic cancer: Focus on clinical symptoms, cachexia-related proteins, and body composition analysis at admission.

Objective: In palliative medicine, accurate prognosis of patients with terminal cancer is crucial. Serum albumin (Alb), transthyretin (TTR), and C-reactive protein (CRP) have been reported to be associated with prognosis. Pancreatic cancer is generally a rapidly progressing disease with an extremely poor prognosis. In the present study, we focused on identifying prognostic factors in patients with terminal pancreatic cancer. Methods: Overall, 756 patients with terminal cancer were admitted for palliative care and died during the 3-year period from April 2018; of these, 72 patients with pancreatic cancer (9.5%; excluding those who died within 7 days of admission) were included in the study. In addition to assessing clinical symptoms at admission, blood tests were performed to measure serum Alb (g/dL), TTR (mg/dL), CRP (mg/dL), and tumor markers. Body composition was analyzed using bioelectrical impedance analysis (BIA; InBody S10) to determine skeletal muscle mass index (SMI, kg/m2), extracellular water to total body water ratio (ECW/TBW), and phase angle (°). Prognostic factors were then evaluated. Results: The median age was 75 years (range: 33-91 years), with a male-to-female ratio of 37:35. The median survival time was 24 days (range: 7-99 days). After adjusting for age, sex, and performance status as potential confounders, multivariate analysis revealed that CRP (hazard ratio [HR]: 1.0998; 95% confidence interval [CI]: 1.0248-1.1781; p=0.0072), ECW/TBW (HR: 1.4391; 95% CI: 1.1429-1.8080; p=0.0018), and depressed mood (HR: 1.155; 95% CI: 1.036-1.281; p=0.0074) were significantly associated with prognosis. The cutoff values for 4-week survival (approximately 1-month survival) were CRP ≥2.0 mg/dL and ECW/TBW ≥0.430. Conclusion: Patients with terminal pancreatic cancer presented with advanced chronic inflammation at admission in addition to cachexia. Multivariate analysis revealed that serum CRP level and ECW/TBW ratio are independent prognostic factors, suggesting that prognosis in terminal pancreatic cancer is associated with the severity of chronic inflammation and edema. Among clinical symptoms, the degree of depression may also be related to prognosis, indicating that psychological distress should be considered in palliative care assessments.