CHANGES in body composition and metabolic markers could enable the early detection of pancreatic ductal adenocarcinoma (PDAC). PDAC is currently the third leading cause of cancer-related mortality in the USA. While early detection is critical for improving survival rates, the lack of specific symptoms in the early stages of the disease poses a significant challenge. Identifying high-risk subgroups in the general population is crucial to improve prognosis.
In a retrospective cohort study spanning from 2002–2021, researchers investigated the longitudinal changes in body composition and metabolic factors preceding a PDAC diagnosis. They identified all patients aged ≥18 years diagnosed with PDAC during the study period, gathering data from abdominal CT scans and 10 blood-based biomarkers taken up to 36 months prior to diagnosis. Utilising a fully automated abdominal segmentation algorithm for 3D quantification of body composition, the team analysed trends using linear mixed models and visualised the data with spline regression.
The study included 1,690 patients for body composition analysis, with 30.5% (516 patients) having two or more pre-diagnostic CT scans. For the analysis of blood-based biomarkers, 3,332 individuals were included. The findings revealed significant changes in body composition and metabolic factors as early manifestations of PDAC.
Notably, a marked decrease in both visceral and subcutaneous adipose tissue was observed closer to the diagnosis date, with β-values of -1.94 (95% CI: -2.39– -1.48) and -2.59 (95% CI: -3.17– -2.02) cm²/m² per 6 months, respectively. Concurrently, there was a significant reduction in serum lipids, including low-density lipoprotein (LDL) (β=-2.83; 95% CI: -3.31– -2.34), total cholesterol (β=-2.69; 95% CI: -3.18– -2.20), and triglycerides (β=-1.86; 95% CI: -2.61– -1.11). An increase in blood glucose levels was also noted. Furthermore, substantial loss of muscle tissue and bone volume was evident in the last 6 months before diagnosis.
The study concludes that these significant alterations in soft tissue and metabolic markers could serve as early indicators of PDAC development. Detecting these changes early offers a promising window for timely diagnosis and intervention, potentially improving patient outcomes in what is typically an aggressive, late-detected cancer.
Ada Enesco, EMJ
Reference
Klatte DCF et al. Temporal trends in body composition and metabolic markers prior to diagnosis of pancreatic ductal adenocarcinoma. Clin Gastroenterol Hepatol. 2024;DOI:10.1016/j.cgh.2024.03.038.
