Dietitian-led individualized pancreatic enzyme replacement therapy is associated with favorable nutritional and immune-inflammatory profiles in pancreatic cancer: a retrospective cohort study.

BACKGROUND

Pancreatic cancer is a highly malignant tumor with extremely poor prognosis. Pancreatic exocrine insufficiency (PEI), malnutrition, and immune-inflammatory dysfunction are highly prevalent and closely interact to impair postoperative recovery and clinical outcomes. Pancreatic enzyme replacement therapy (PERT) is the standard care for PEI; however, evidence regarding the association between dietitian-led individualized PERT and nutritional as well as immune-inflammatory profiles remains limited.

METHODS

This retrospective cohort study enrolled 123 patients with histologically confirmed pancreatic cancer who underwent surgical resection at Nanjing Drum Tower Hospital, affiliated to Nanjing University Medical School, from January 2018 to December 2023. Patients were retrospectively allocated to the Individualized PERT group (n = 58) and the Standard PERT group (n = 65) according to the type of PERT received in clinical practice. The Individualized PERT group received dietitian-led PERT combined with regular nutritional counseling, whereas the Standard PERT group received standard clinical PERT regimen combined with regular nutritional counseling. Baseline characteristics, nutritional parameters, body composition indices, hematological and immune-inflammatory biomarkers, as well as postoperative complications and 30-day readmission rates were collected and analyzed. Multivariable linear regression and Gamma generalized linear models (GLMs) were applied to adjust for confounding factors, including tumor stage, baseline hemoglobin and skeletal muscle index (SMI).

RESULTS

Dietitian-led individualized PERT was significantly associated with better preservation of body weight. The mean difference in weight change between the Individualized PERT and Standard PERT groups was 3.29 kg (95% CI: 1.32-5.27; P = 0.001). The corresponding mean percentage weight change was-1.53% ± 8.03% in the Individualized PERT group and-6.90% ± 9.07% in the Standard PERT group, with a mean difference of 5.37% (95% CI: 2.32%-8.43%; P < 0.001). No significant between-group difference was observed for serum albumin (P = 0.110), despite a positive trend. Body composition analysis confirmed that individualized PERT was associated with milder loss of skeletal muscle mass and adipose tissue. Furthermore, key immune-inflammatory biomarkers, including lymphocyte count and the lymphocyte-C-reactive protein ratio, showed more favorable levels in the Individualized PERT group. After multivariate adjustment, individualized PERT remained independently associated with improved body weight, body mass index (BMI), SMI, reduced C-reactive protein-to-albumin ratio (CAR) and higher LCR. There were no significant differences between the groups in the rates of postoperative complications (P = 0.588) or 30-day readmission (P = 0.326).

CONCLUSION

In this retrospective cohort study, dietitian-led individualized PERT combined with nutritional counseling is independently associated with favorable nutritional and immune-inflammatory profiles among pancreatic cancer patients with PEI after adjusting for major confounders.