Pancreatic adenocarcinoma nutritional-clinical index (PANCIN): A novel prognostic tool in advanced pancreatic cancer

BACKGROUND & AIMS: Nutritional status alterations are common in pancreatic ductal adenocarcinoma (PDAC), but their prognostic role in patients undergoing chemotherapy remains unclear. We assessed the impact of clinical-nutritional variables on treatment outcomes in advanced PDAC patients. METHODS: Clinical, anthropometric, and radiological data of locally advanced/metastatic PDAC patients treated with polychemotherapy (2019-2021), prospectively collected within the observational PAC-MAIN study (NCT04112836) were analyzed. Key predictors of progression-free (PFS) and overall survival (OS) were identified through a multistep feature selection process, developing the Pancreatic Adenocarcinoma Nutritional-Clinical Index (PANCIN). Associations with CA19.9, radiological response, chemotherapy dose intensity and toxicity were explored. RESULTS: Among 74 patients, Vitamin B12 levels, Mid-Upper Arm Circumference, and Visceral Fat-to-Muscle area Ratio were included in the PANCIN, emerging as strongest PFS/OS predictors. According to PANCIN stratification, median PFS was 6.2 (95% CI 3.5-9.7) vs 14.1 (8.8-20.3) months, and median OS was 10.4 (7.5-15.1) vs 19.8 (11.3-31.1) months, for high- vs low-risk patients, respectively (p < 0.001). PANCIN significantly correlated with CA19.9 and radiological response, infections and grade ≥3 hematologic toxicities. CONCLUSIONS: PANCIN is a novel prognostic tool combining clinical-nutritional and radiological features, potentially aiding risk stratification and early nutritional support in advanced PDAC patients.