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Supportive Care in Cancer
Published in: Supportive Care in Cancer 3/2011

01-03-2011 | Original Article

Interaction of gonadal status with systemic inflammation and opioid use in determining nutritional status and prognosis in advanced pancreatic cancer

Authors: Richard J. E. Skipworth, Alastair G. W. Moses, Kathryn Sangster, Catharine M. Sturgeon, Anne C. Voss, Marie T. Fallon, Richard A. Anderson, James A. Ross, Kenneth C. H. Fearon

Published in: Supportive Care in Cancer | Issue 3/2011

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Abstract

Purpose

Hypogonadism has been linked with systemic inflammation and opioid use in males with advanced cancer. We aimed to investigate the interaction of gonadal status with systemic inflammation and opioids in determining nutritional status and prognosis in advanced pancreatic cancer.

Methods

One hundred and seventy-five patients (92 males, 83 postmenopausal females) with unresectable pancreatic cancer were studied. Serum sex steroids (total testosterone [TT], calculated free testosterone [cFT], oestradiol, sex hormone binding globulin), gonadotropins (follicle-stimulating hormone and luteinising hormone) and pro-inflammatory mediators (C-reactive protein [CRP], interleukin-6 [IL-6], soluble tumour necrosis factor receptor 75 [sTNFR75]) were measured, and nutritional assessment and opioid use recorded.

Results

Seventy-three percent of males were hypogonadal (by cFT definition). cFT correlated positively with BMI (r 2 = 0.349; p < 0.001) and grip strength (r 2 = 0.229; p = 0.034) and inversely with weight loss (r 2 = −0.287; p = 0.007), CRP (r 2 = −0.426; p < 0.001) and IL-6 (r 2 = −0.303; p = 0.004). CRP (p = 0.007), opioid dosage (p = 0.009) and BMI (p = 0.005) were independent determinants of cFT on ANOVA. Hypogonadal males demonstrated worsened survival compared with eugonadal patients (TT: OR of death = 2.87; p < 0.001; cFT: OR = 2.26; p = 0.011). Furthermore, male opioid use was associated with decreased TT (p < 0.001) and cFT (p < 0.001) and worsened survival (OR = 1.96; p = 0.012). In contrast, 18% of postmenopausal females exhibited premenopausal (“hyperoestrogenic”) oestradiol levels. Oestradiol correlated positively with sTNFR75 (r 2 = 0.299; p = 0.008). CRP (p < 0.001) was an independent determinant of oestradiol. Hyperoestrogenic females demonstrated worsened survival compared with eugonadal patients (OR = 2.43; p = 0.013).

Conclusions

In males with pancreatic cancer, systemic inflammation and opioid use are associated with hypogonadism. Male hypogonadism and female hyperoestrogenism are associated with shortened survival in advanced pancreatic cancer.
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Metadata
Title
Interaction of gonadal status with systemic inflammation and opioid use in determining nutritional status and prognosis in advanced pancreatic cancer
Authors
Richard J. E. Skipworth
Alastair G. W. Moses
Kathryn Sangster
Catharine M. Sturgeon
Anne C. Voss
Marie T. Fallon
Richard A. Anderson
James A. Ross
Kenneth C. H. Fearon
Publication date
01-03-2011
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 3/2011
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-010-0832-y

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