SEVERE ENCASEMENT OF SUPERIOR MESENTERIC ARTERY OR CELIAC ARTERY RELATES PAIN AND GASTROINTESTINAL SYMPTOMS IN PATIENTS RECEIVING CHEMOTHERAPY FOR ADVANCED PANCREATIC CANCER

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Abstract

Background

Pancreatic cancer (PC) with severe arterial encasement (more than 180°) of the superior mesenteric artery (SMA) or celiac artery (CeA) is considered unresectable. Severe arterial encasement is important for the management of PC patients, but its clinical significance in advanced PC is unclear. The aim of this study was to identify the impact of severe arterial encasement on symptoms, body composition, and outcome among patients receiving chemotherapy for advanced PC.

Methods

Patients with treatment-naïve, unresectable PC and no obvious infectious conditions were eligible for enrollment. The symptoms were rated numerically from 0 to 10 using the Japanese version of the MD Anderson Symptom Inventory. Body composition was evaluated using a bioelectrical impedance analysis. The measurements were carried out before the start of chemotherapy. The overall survival time (OS) was calculated from the start of chemotherapy. Severe arterial encasement was defined as tumor abutment of the SMA or CeA exceeding 180 degrees of the circumference of the vessel wall on dynamic computed tomography images, as assessed by first author.

Results

Ninety-three patients (female/male: 44/49, PS 0/1/2: 66/26/1, median age: 66 years) were enrolled. All the patients received chemotherapy (GEM/GEM-based/S-1: 56/21/16). Severe arterial encasement and liver metastasis were found in 37 and 44 patients, respectively. Severe arterial encasement did not impact the OS (HR, 1.20; P = 0.427) but shortened the OS of patients without liver metastasis (HR, 1.99; P = 0.037). The severity of nausea and appetite loss and the dosage of morphine were higher in the severe arterial encasement group (P = 0.002, P = 0.025, P = 0.045, respectively). The fat mass tended to be lower among patients with severe arterial encasement (P = 0.079).

Conclusions

Severe arterial encasement is related to pain and digestive symptoms among patients with advanced PC and has a prognostic impact among patients without liver metastasis.

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