Effect of the preoperative prognostic nutritional index on the long-term prognosis in patients with borderline resectable pancreatic cancer after pancreaticoduodenectomy

Abstract

BackgroundThe preoperative prognostic nutritional index (PNI) is an indicator of systemic immune-nutritional condition and is a well-known prognostic biomarker in cancer patients. This study aims to reflect the correlation between the preoperative PNI and prognosis in patients with borderline resectable pancreatic cancer (BRPC) after pancreaticoduodenectomy (PD).MethodsMedical records of patients with BRPC after PD between Jan 2011 and Dec 2021 in our hospital were retrospectively analyzed. The preoperative PNI was calculated, and the receiver operating characteristic curve was obtained based on the preoperative PNI and the 1-year survival rate. Patients were divided into two groups (High-PNI and Low-PNI) following the best cut-off value of the preoperative PNI, and demographic and pathologic findings were compared between the two groups. Univariate and multivariate analysis were performed to identify risk factors in recurrence and long-term survival.ResultsThe best cut-off value for the preoperative PNI was 44.6 (sensitivity: 62.46%; specificity: 83.33%; area under the curve: 0.724). Patients in the low-PNI group had significantly shorter recurrence-free survival (P=0.008) and overall survival (P=0.009). The preoperative PNI (P=0.009) and lymph node metastasis (P=0.04) were independent risk factors for tumor recurrence. The preoperative PNI (P=0.001), lymph node metastasis (P=0.04), neoadjuvant chemotherapy (P=0.04) were independent risk factors for long-term survival in patients.ConclusionThe preoperative PNI, lymph node metastasis, neoadjuvant chemotherapy were independent risk factors for recurrence and long-term survival in patients with BRPC. The preoperative PNI might be an indicator that can predict BRPC patients’ recurrence and survival. Patients with high-PNI would benefit from neoadjuvant chemotherapy.

Prognostic significance of preoperative lymphocytes, albumin, and neutrophils (LANR) index in resectable pancreatic ductal adenocarcinoma

“…In this study, we investigated the predictive value of 12 clinicopathologic variables (gender, age, tumor size, degree of differentiation, tumor location, TNM stage, lymph node metastasis, vascular cancer thrombus, peripheral nerve invasion, CEA, CA199, CA125) for resectable pancreatic ductal adenocarcinoma, and many attempts have been made to determine the prognostic factors of PDAC in addition to several well-known factors such as TNM stage and carbohydrate antigen 19 − 9 (CA19-9) [ 25 ],In several previous studies, LN status and degree of tumor differentiation were identified as prognostic factors for resectable PDAC [ 26 – 28 ],and these findings are consistent with the results of this study, which suggest that LN status and degree of differentiation are independent prognostic factors in patients with PDAC. In addition, studies have shown that neoadjuvant chemotherapy can inhibit tumor progression and effectively prolong postoperative survival [ 29 ].however, there is still a lack of uniform criteria for selecting patients who are candidates for neoadjuvant therapy. In our study, we did not include these patients in order to rule out the effect of preoperative neoadjuvant chemotherapy on our outcomes.…”

“…Malnutrition is a common diagnosis among cancer patients and has a considerable effect on the prognosis [ 29 ].Progressive malnutrition is strongly associated with the development of cachexia, especially in patients with pancreatic and gastric cancers [ 30 ].Epidemiological studies on the relationship between serum albumin levels and survival in cancer patients have found that decreased serum albumin levels are associated with reduced survival [ 31 ].The relationship between pretreatment albumin levels and prognosis for head and neck cancer [ 32 ],kidney cancer [ 33 ], cardia adenocarcinoma [ 34 ], and ovarian cancer [ 35 ] has been reported. Inflammation is known to play a key role in the initiation, progression, and prognosis of tumors, and lymphocytes can not only effectively recognize tumor cells, but also be stimulated by tumor antigens to transform into sensitized lymphocytes to attack tumor lesions, thereby producing antitumor activity, inhibiting angiogenesis, and improving tumor prognosis [ 35 ].…”