Body mass index has no impact on complications and mortality for patients with stage IV pancreatic ductal adenocarcinoma

Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of United States (USA) cancer death. Overweight and obesity developing into a growing global medical and socio-economic problem, affecting approximately 42% of adults in the USA population. The aim of our analysis was to evaluate the influence of overweight and obesity on complications and clinical outcome in patients with stage IV PDAC. Methods: We retrospectively reviewed electronic health records of patients diagnosed with stage IV PDAC (n=162) who followed with the University of Kentucky from January 2017–October 2024. Comparisons were based on the body mass index (BMI): low BMI (BMI <25 kg/m²) vs. high BMI (BMI ≥25 kg/m²). Associations between groups were analysed by Chi Square method, t-tests, and if needed, Fischer exact test. Results: Smoking status showed significant higher current and former smokers in the high BMI group (P=0.005). No significant difference was seen for lab parameter. Hypertension was the most frequent comorbidity (n=101). Type 2 diabetes was significantly more prevalent in the high BMI group (55.8% vs. 38.2%; P=0.03). FOLFIRINOX (fluorouracil, leucovorin, irinotecan, oxaliplatin) therapy was more frequent in the high BMI group (44.2% vs. 34.2%). No significant differences were observed between the groups in terms of chemotherapy lines or complications, including thrombosis, infection, endoscopic interventions and gastrointestinal (GI) bleeding. No difference for mortality was observed. Conclusions: Our data clearly show that neither higher nor lower BMI is a contraindication for systemic chemotherapy of stage IV PDAC. Complications and mortality were not different between the groups. However, hospice referrals were more frequent in patients with low BMI, which may be from cognitive biases due to the more cachectic appearing phenotype.