Preoperative independent prognostic factors in patientswith borderline resectable pancreatic adenocarcinoma following curative resection: Neutrophil-lymphocyteratio and platelet-lymphocyte ratio
- VernacularTitle:Мэс заслын аргаар эмчлэгдэх боломжийн зааг нойр булчирхайн өмөнгийн төгс мэс засал эмчилгээний дараах амьдрах чадварыг тодорхойлох хүчин зүйл: Нейтрофил-Лимфоцитийн харьцаа ба Ялтас эс-Лимфоцитийн харьцаа
- Author:
Sadaki Asari
;
Hirochika Toyama
;
Ippei Matsumoto
;
Tadahiro Goto
;
Jun Ishida
;
Yoshihide Nanno
;
Azusa Ueta
;
Tetsuo Ajiki
;
Masahiro Kido
;
Takumi Fukumoto
;
Yonson Ku
- Collective Name:Kinki University Faculty of Medicine, Osakasayama, Japan
- Publication Type:journal article
- From:Innovation
2014;8(4):110-111
- CountryMongolia
- Language:English
-
Abstract:
Background: Borderline resectable pancreatic adenocarcinoma (BR-PAC) is
defined as locally advanced tumor of the pancreas without metastasis that is,
although potentially resectable (R), at high risk for positive resection margin
following surgery. The therapeutic strategy has remained unestablished because
BR-PAC is biologically a heterogeneous subset in which the preoperative
prognostic factors are undetermined. Recently, several prognostic factors related
to systemic inflammation have been explored in various kinds of cancers: the
combination of serum C-reactive protein (CRP) and albumin as the modified
Glasgow prognostic factor; a combination of CRP and white blood cell count
in the prognostic index; a combination of albumin and lymphocyte counts in
Onodera’s prognostic nutritional index; the neutrophil-lymphocyte ratio (NLR);
and the platelet-lymphocyte ratio (PLR). Although these prognostic factors have
been explored in some small cohort studies of PAC patients, the results still remain
controversial especially because PAC patients with diverse clinical stages were
included in the cohorts. It has never been reported whether or not the systemic
inflammatory response is validated as a predictive risk factor in cohorts of only
advanced BR-PAC patients.
Method: Between January 2003 and June 2012 at Kobe University Hospital,
136 consecutive pancreatic adenocarcinoma (PAC) patients who underwent
surgical curative resection were retrospectively studied. Prior to surgery, the PAC
patients were stratified into R- and BR-PAC patients according to the National
Comprehensive Cancer Network guidelines. To evaluate the independent
prognostic significance of NLR and PLR, univariate and multivariate Cox
proportional-hazard models were applied.
Results: The median survival in PAC patients with preoperative NLR > 3 (n=45)
and NLR < 3 (n=91) was 17.5 months and 31.1 months, respectively (P=0.0037).
However, the median survival in PAC patients with PLR > 225 (n=32) and PLR
< 225 (n=104) was 21.8 months and 26.2 months, showing no significant
difference in overall survival between the two groups (P=0.2526). The median
survival in the R-PAC patients with NLR > 3 (n=38) and NLR < 3 (n=70) was 18.1
months and 33.1 months, respectively (P=0.0138). However, the median survival
in the R-PAC patients with PLR > 225 (n=27) and PLR < 225 (n=81) was 24.1
months and 25.8 months, showing no significant difference in overall survival
between the two groups (P=0.6533). The median survival in BR-PAC patients
with preoperative NLR > 3 (n=7) and NLR < 3 (n=21) was 14.8 months and 27.2
months, respectively (P=0.0068). In addition, median survival in BR-PAC patients
with preoperative PLR > 225 (n=5) and PLR < 225 (n=23) was 14.8 months and
26.2 months, respectively (P=0.0050). Preoperative NLR > 3 (HR=21.437, 95%
CI=4.119-142.980; P=0.0002) and PLR > 225 (HR=30.993, 95% CI=3.844-
384.831; P=0.0009) were the only independent prognostic factors in BR-PAC
patients.
Conclusion: Preoperative NLR and PLR offer independent prognostic information
regarding overall survival in BR-PAC patients following curative resection. The
workup is only to obtain a blood sample of 3 mL from PAC patients immediately
before treatment. In the near future, these factors associated with the systemic
inflammatory response may have the potential to become criteria for BRPAC
candidates to undergo neoadjuvant chemotherapy and/or neoadjuvant
chemoradiation followed by surgical resection
