E294: Association of Sex and Obesity on Overall Survival in Patients Undergoing Upfront Surgery for Resectable Pancreatic Adenocarcinoma

Introduction: The influence of high BMI on outcomes in pancreatic adenocarcinoma (PDAC) remains an area of active investigation. We investigate the association between obesity (BMI ≥30) and sex in outcomes for patients with resectable PDAC undergoing upfront surgery.

Methods: A prospectively maintained pancreatic cancer database at Memorial Sloan Kettering Cancer Center was queried to identify all patients undergoing upfront surgery with a pathologic diagnosis of PDAC. Clinicodemographic variables and outcomes were collected and analyzed. Multivariable Cox regression was used to investigate the association between BMI and sex on overall survival (OS) while adjusting for known confounders such as age, receipt of adjuvant therapy, pathologic T/N stages, margin status, lymphovascular invasion and perineural invasion.

Results: From 2012-2022 we identified 978 patients who underwent upfront surgery with a final pathologic diagnosis of PDAC. In the entire cohort, median age was 70 years (range 63-77 years), 52% were male and 24% were obese (BMI ≥30). Adjuvant therapy was initiated in 82% of patients and median follow-up and overall survival were 39 months and 31 months, respectively. On multivariable analysis, obesity was not associated with OS. However, when dichotomized by sex (male or female) and obesity (BMI < 30 or ≥30), obese males had a significant association with decreased OS (HR 1.56. 95% CI 1.12-2.15, P=0.008) compared to obese females. There was no significant association in OS between non-obese females vs. obese females (HR 1.03, 95% CI 0.78-1.36, P=0.82) and non-obese males vs. obese females (HR 1.17, 95% 0.90-1.53, P=0.25).

Conclusions: There is an association between obese males and worse overall survival compared to obese females. Obesity may have differential effects based on sex in those patients undergoing upfront surgery for PDAC. Ongoing investigation into the host- and tumor-specific factors that may underlie this difference is needed and could lead to better understanding of how these variables can be modified for improved outcomes in PDAC.