Recurrence rates after resection for pancreatic cancer are high, with >70% of patients developing recurrence within 1 year following their index operation.1 While guidelines recommend close surveillance with cross-sectional imaging every 3–6 months postoperatively for the first 2 years, population-level studies show that only 40% of patients actually undergo imaging surveillance by the 2-year mark.2 Additionally, the current gold-standard serum biomarker, carbohydrate antigen (CA) 19-9, is not synthesized in 10% of patients and is normal in another one-third of patients, limiting its clinical utility.3,4 While patient weight is routinely recorded during physician visits, the significance of longitudinal weight tracking has not been rigorously assessed, and, as such, its prognostic significance and added value to existing surveillance programs remains largely unknown.
In this study by Hue and colleagues, the authors provided a novel assessment of the associations of weight change following pancreatectomy with outcomes using robust institutional data. In their analysis, the authors explored the impact of weight change in patients with malignant disease and compared this with patients with benign disease. In doing so, the authors were able to ‘extract’ the impact of malignancy and determine the effect of the operation itself on changes in weight. The authors subsequently evaluated the association between changes in weight and outcomes, including disease recurrence and overall survival, in patients with pancreatic ductal adenocarcinoma (PDAC).5 While there were some inherent differences between the benign and malignant groups, the authors found that most patients lost more than 20 pounds following pancreatectomy. In addition, the weight loss was durable, with most failing to regain weight back to their baseline status. Patients with benign disease ended up with a total of 5.6% weight loss compared with PDAC patients, who suffered 8.5% weight loss, thus revealing that most weight loss was ‘operation mediated’, but that a significant proportion was ‘cancer-related’. However, the most important findings of this study lie in the PDAC subgroup analysis. For patients with pancreatic cancer, the authors found that those who developed early recurrence lost significantly more weight compared with patients who did not develop disease recurrence (18% vs. 11%; p < 0.001). Additionally, patients with early recurrences took 7.5 months to reach their nadir weight postoperatively, which was substantially and statistically significantly longer than patients without evidence of disease recurrence (2 months). This association remained significant after adjusting for confounders. In fact, patients who did not achieve their nadir weight within 12 months of their operation experienced 3.2 times higher odds of having disease recurrence.