Relationship between cachexia and perineural invasion in pancreatic adenocarcinoma

doi:10.4251/wjgo.v11.i12.1126

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Oncol. Dec 15, 2019; 11(12): 1126-1140
Published online Dec 15, 2019. doi: 10.4251/wjgo.v11.i12.1126

Table 1 Patient characteristics in the adenocarcinoma and control groups, n (%)

Characteristics	PDAC (n = 114)	Control (n = 125)
Age (yr), mean (SD)	64.76 (10.58)^b	60.26 (12.03)
Age > 50 yr	103 (90.35)^b	89 (71.2)
Sex (female)	47 (41.23)	46 (36.8)
BMI (kg/m²), median (IQR)	25.09 (22.05-27.25)	25.26 (22.58-28.72)
Weight status
Underweight	12 (10.53)	5 (4)
Normal	48 (42.11)	53 (42.4)
Overweight	37 (32.46)	44 (35.2)
Obesity	17 (14.91)	23 (18.4)
Smoking	50 (43.86)	69 (55.2)
New-onset diabetes	24 (21.05)^b	8 (6.4)
Long-term diabetes	24 (21.05)	32 (25.6)
Diabetes	49 (42.98)^a	38 (30.4)
CA 19-9 (U/mL), median (IQR)	400 (67.75-400)^b	31.45 (9.58-98.8)
Cachexia	22 (19)	8 (6)
T stage	1-2: 10 (8.85); 3: 65 (57.52); 4: 38 (33.63)
Histological grade	G1: 8/41 (19.51); G2: 24/41 (58.54); G3: 12/41 (29.27)
N stage	9 (8.18)
Metastasis	48 (42.11)

^aP < 0.05,

^bP < 0.01 vs controls. PDAC: Pancreatic ductal adenocarcinoma; BMI: Body-mass index; CA 19-9: Carbohydrate antigen 19-9; QR: Interquartile range; CI: Confidence interval.

Table 2 Protein plasma expression in adenocarcinoma patients and interaction with clinical and biological parameters, n (%)

Protein expression	Midkine		Activin
Protein expression	Low (n = 60)	High (n = 54)	Low (n = 42)	High (n = 72)
Age (yr), mean (SD)	63.02 (10.06)	66.7 (10.91)	63.64 (10.4)	65.42 (10.7)
BMI (kg/m²), median (IQR)	24.34 (20.71-26.54)	25.79 (23.11-27.52)^a	25.66 (22.24-27.52)	24.52 (22.05-26.94)
CA 19-9 (U/mL), median (IQR)	400 (53.5-400)	352 (70-400)	400 (53.5-400)	191 (70-400)
Age > 50 yr	53 (88.33)	50 (92.59)	36 (85.71)	67 (93.06)
Sex (female)	27 (45)	20 (37.04)	18 (42.86)	29 (40.28)
Stage (III-IV vs I-II)	28 (46.67)	39 (72.22)^b	20 (47.62)	47 (65.28)
Histological grade
G1	3 (16.67)	4 (17.39)	3 (16.67)	4 (17.39)
G2	10 (55.56)	12 (52.17)	13 (72.22)	9 (39.13)
G3	5 (27.78)	7 (30.43)	2 (11.11)	10 (43.48)
Metastasis	20 (33.33)	28 (51.85)^a	14 (33.33)	34 (47.22)
Tumor size ≥ 3 cm	44 (78.57)	43 (87.76)	30 (75)	57 (87.69)
Weight loss of 5% over the past 6 mo	45 (90)	29 (82.86)	11 (26)	23 (32)
Weight
Underweight	9 (15)	3 (5.56)	3 (7.14)	9 (12.5)
Normal	28 (46.67)	20 (37.04)	16 (38.1)	32 (44.44)
Overweight	15 (25)	22 (40.74)	14 (33.33)	23 (31.94)
Obesity	8 (13.33)	9 (16.67)		8 (11.11)
Smoking	32 (53.33)	18 (33.33)^a	17 (40.48)	33 (45.83)
New-onset diabetes	16 (26.67)	8 (14.81)	8 (19.05)	16 (22.22)
Long-term diabetes	6 (10)	18 (33.33)^b	10 (23.81)	14 (19.44)
Diabetes	22 (36.67)	27 (50)	18 (42.86)	31 (43.06)
IHC
Negative	36 (60)	22 (40.74)^a	29 (69.05)	26 (36.11)^b
Weak	18 (30)	16 (29.63)	11 (26.19)	42 (58.33)
Moderate	5 (8.33)	11 (20.37)	2 (4.76)	4 (5.56)
Strong	1 (1.67)	5 (9.26)
Immunohistochemistry perineural invasion (appearances on slide)	2: 3 (9.09); 0: 17 (51.52); 1: 13 (39.39)	2: 9 (32.14)^a; 0: 7 (25); 1: 12 (42.86)	2: 5 (17.86); 0: 13 (46.43); 1: 10 (35.71)	2: 7 (21.21); 0: 11 (33.33); 1: 15 (45.45)
Cachexia	16 (73)	6 (27)	15 (26)	7 (32)

^aP < 0.05,

^bP < 0.01. BMI: Body-mass index; CA 19-9: Carbohydrate antigen; IHC: Immunohistochemistry; IQR: Interquartile range; CI: Confidence interval.

Table 3 Univariate and multivariate analysis to predict metastasis

	Univariate analyses			Multivariate analyses
	OR unadjusted	95%CI	P value	OR unadjusted	95%CI	P value
Age > 50 yr	0.95	0.23-4.16	0.942	1.24	0.33-5.2	0.75
Sex (male vs female)	1.25	0.53-2.99	0.617	1.27	0.56-2.91	0.571
N1	2.04	0.53-10.09	0.326	2.27	0.61-10.92	0.251
Tumor size ≥ 3 cm	0.87	0.28-2.8	0.809	1.13	0.4-3.39	0.821
Midkine expression (high-expressed vs low-expressed)	2.12	0.92-5	0.08	1.92	0.87-4.33	0.11
Activin expression (high-expressed vs low-expressed)	1.94	0.78-5.01	0.157	1.62	0.71-3.81	0.261

OR: Odds ratio; HR: Hazard ratio; CI: Confidence interval.

Table 4 Univariate and multivariate analysis to predict survival

	Univariate analyses			Multivariate analyses
	HR adjusted	95%CI	P value	HR adjusted	95%CI	P value
Age > 50 yrs	2.43	1.18-5.01	0.016	1.9	0.86-4.2	0.113
Sex (male vs female)	0.51	0.34-0.76	0.001	0.66	0.42-1.05	0.078
N1	1.42	0.74-2.73	0.299	1.13	0.54-2.36	0.745
Tumor size ≥ 3 cm	2.13	1.13-4.01	0.02	2.36	1.21-4.62	0.012
Metastases	2.09	1.4-3.12	< 0.001	1.62	1.01-2.62	0.047
Midkine expression (high-expressed vs low-expressed)	1.67	1.12-2.48	0.011	0.76	0.48-1.2	0.24
Activin expression (high-expressed vs low-expressed)	3.61	2.34-5.56	< 0.001	1.98	1.2-3.27	0.008

OR: Odds ratio; HR: Hazard ratio; CI: Confidence interval.

Citation: Petrusel L, Rusu I, Leucuta DC, Seicean R, Suharoschi R, Zamfir P, Seicean A. Relationship between cachexia and perineural invasion in pancreatic adenocarcinoma. World J Gastrointest Oncol 2019; 11(12): 1126-1140
URL: https://www.wjgnet.com/1948-5204/full/v11/i12/1126.htm
DOI: https://dx.doi.org/10.4251/wjgo.v11.i12.1126