The role of systemic immuno-inflammatory factors in resectable pancreatic adenocarcinoma: a cohort retrospective study

D Schlanger, C Popa, S Pașca, A Seicean, N Al Hajjar, D Schlanger, C Popa, S Pașca, A Seicean, N Al Hajjar

Abstract

Background: Pancreatic cancer is an aggressive malignancy, surgery being the only potentially curative treatment. The systemic inflammatory response is an important factor in the development of cancer. There is still controversy regarding its role in pancreatic cancer.

Methods: Our study is a retrospective observational cohort study. We included patients diagnosed with pancreatic ductal adenocarcinoma (PDAC), who underwent surgical resection in our hospital, between January 2012 and December 2019. We gathered information from preoperative and postoperative blood tests. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), prognostic nutritional index (PNI) and systemic immune-inflammation index (SII) were determined.

Results: We included 312 patients. All the immune-inflammatory scores assessed significantly changed after the surgery. The impact on overall survival of these markers showed that only some of the postoperative scores predicted survival: high PLR had a negative prognostic impact, while high lymphocyte and PNI values had a positive effect on overall survival.

Discussion: The circulating immune cells and their values integrated in the assessed prognostic scores suffer statistically significant changes after curative pancreatic surgery. Only the postoperative values of lymphocyte count, PLR, and PNI seem to influence the overall survival in PDAC.

Trial registration: ClinicalTrials.gov-identifier NCT05025371 .

Keywords: Cancer prognosis; Pancreatic cancer; Platelet to lymphocyte ratio; Prognostic nutritional index; Systemic inflammatory response.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves showing the association of postoperative lymphocyte count, PLR, and PNI on overall survival

References

    1. Haeberle L, Esposito I. Pathology of pancreatic cancer. Transl Gastroenterol Hepatol. 2019;4:50. doi: 10.21037/tgh.2019.06.02.
    1. Ducreux M, Cuhna AS, Caramella C, Hollebecque A, Burtin P, Goéré D, et al. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26:v56–v68. doi: 10.1093/annonc/mdv295.
    1. Lambert A, Schwarz L, Borbath I, Henry A, van Laethem J-L, Malka D, et al. An update on treatment options for pancreatic adenocarcinoma. Ther Adv Med Oncol. 2019;11:1758835919875568. doi: 10.1177/1758835919875568.
    1. Harris M, Brekke M, Dinant G-J, Esteva M, Hoffman R, Marzo-Castillejo M, et al. Primary care practitioners’ diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries. BMJ Open. 2020;10:e035678. doi: 10.1136/bmjopen-2019-035678.
    1. Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly DS, et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer. 2011;47:2633–2641. doi: 10.1016/j.ejca.2011.03.028.
    1. Colotta F, Allavena P, Sica A, Garlanda C, Mantovani A. Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability. Carcinogenesis. 2009;30:1073–1081. doi: 10.1093/carcin/bgp127.
    1. Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G, et al. STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery. Int J Surg. 2019;72:156–165. doi: 10.1016/j.ijsu.2019.11.002.
    1. Ahmad J, Grimes N, Farid S, Morris-Stiff G. Inflammatory response related scoring systems in assessing the prognosis of patients with pancreatic ductal adenocarcinoma: a systematic review. Hepatobiliary Pancreat Dis Int. 2014;13:474–481. doi: 10.1016/S1499-3872(14)60284-8.
    1. Mowbray NG, Griffith D, Hammoda M, Shingler G, Kambal A, Al-Sarireh B. A meta-analysis of the utility of the neutrophil-to-lymphocyte ratio in predicting survival after pancreatic cancer resection. HPB. 2018;20:379–384. doi: 10.1016/j.hpb.2017.12.009.
    1. Oh D, Pyo J-S, Son BK. Prognostic roles of inflammatory markers in pancreatic cancer: comparison between the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio. Gastroenterol Res Pract. 2018;2018:9745601. doi: 10.1155/2018/9745601.
    1. Lee SH, Chung MJ, Kim B, Lee HS, Lee HJ, Heo JY, et al. The significance of the prognostic nutritional index for all stages of pancreatic cancer. Nutr Cancer. 2017;69:512–519. doi: 10.1080/01635581.2016.1250921.
    1. McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care. 2009;12:223–226. doi: 10.1097/MCO.0b013e32832a7902.
    1. Arrieta O, Michel Ortega RM, Villanueva-Rodríguez G, Serna-Thomé MG, Flores-Estrada D, Diaz-Romero C, et al. Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study. BMC Cancer. 2010;10:50. doi: 10.1186/1471-2407-10-50.
    1. Argilés JM, Busquets S, López-Soriano FJ. Cytokines in the pathogenesis of cancer cachexia. Curr Opin Clin Nutr Metab Care. 2003;6:401–406. doi: 10.1097/.
    1. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454:436–444. doi: 10.1038/nature07205.
    1. Kinoshita A, Onoda H, Imai N, Iwaku A, Oishi M, Fushiya N, et al. Comparison of the prognostic value of inflammation-based prognostic scores in patients with hepatocellular carcinoma. Br J Cancer. 2012;107:988–993. doi: 10.1038/bjc.2012.354.
    1. Krakowska M, Dębska-Szmich S, Czyżykowski R, Zadrożna-Nowak A, Potemski P. The prognostic impact of neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio in patients with advanced colorectal cancer treated with first-line chemotherapy. Prz Gastroenterol. 2018;13:218–222. doi: 10.5114/pg.2018.78287.
    1. Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 2005;91:181–184. doi: 10.1002/jso.20329.
    1. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102:5–14.
    1. Zhang Y, Wu W, Dong L, Yang C, Fan P, Wu H. Neutrophil to lymphocyte ratio predicts persistent organ failure and in-hospital mortality in an Asian Chinese population of acute pancreatitis. Medicine (Baltimore) 2016;95:e4746. doi: 10.1097/MD.0000000000004746.
    1. Hu B, Yang X-R, Xu Y, Sun Y-F, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20:6212–6222. doi: 10.1158/1078-0432.CCR-14-0442.
    1. Chen J-H, Zhai E-T, Yuan Y-J, Wu K-M, Xu J-B, Peng J-J, et al. Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol. 2017;23:6261–6272. doi: 10.3748/wjg.v23.i34.6261.
    1. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai zasshi. 1984;85:1001–1005.
    1. Hua X, Long Z-Q, Huang X, Deng J-P, He Z-Y, Guo L, et al. The value of prognostic nutritional Index (PNI) in predicting survival and guiding radiotherapy of patients with T1-2N1 breast cancer. Front Oncol. 2020;9:1562. doi: 10.3389/fonc.2019.01562.
    1. Hoshimoto S, Hishinuma S, Shirakawa H, Tomikawa M, Ozawa I, Ogata Y. Validation and clinical usefulness of pre- and postoperative systemic inflammatory parameters as prognostic markers in patients with potentially resectable pancreatic cancer. Pancreatology. 2020;20:239–246. doi: 10.1016/j.pan.2019.12.004.
    1. Zhou Y, Cheng S, Fathy AH, Qian H, Zhao Y. Prognostic value of platelet-to-lymphocyte ratio in pancreatic cancer: a comprehensive meta-analysis of 17 cohort studies. Onco Targets Ther. 2018;11:1899–1908. doi: 10.2147/OTT.S154162.
    1. Hu R, Ma J, Hu G. Lymphocyte-to-monocyte ratio in pancreatic cancer: prognostic significance and meta-analysis. Clin Chim Acta. 2018;481:142–146. doi: 10.1016/j.cca.2018.03.008.
    1. Li S, Tian G, Chen Z, Zhuang Y, Li G. Prognostic role of the prognostic nutritional index in pancreatic cancer: a meta-analysis. Nutr Cancer. 2019;71:207–213. doi: 10.1080/01635581.2018.1559930.
    1. Jomrich G, Gruber ES, Winkler D, Hollenstein M, Gnant M, Sahora K, et al. Systemic immune-inflammation index (SII) predicts poor survival in pancreatic cancer patients undergoing resection. J Gastrointest Surg. 2020;24:610–618. doi: 10.1007/s11605-019-04187-z.
    1. Kim EY, Hong TH. Changes in total lymphocyte count and neutrophil-to-lymphocyte ratio after curative pancreatectomy in patients with pancreas adenocarcinoma and their prognostic role. J Surg Oncol. 2019;120:1102–1111. doi: 10.1002/jso.25725.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться