Evaluation of inflammation‑based markers for predicting the prognosis of unresectable pancreatic ductal adenocarcinoma treated with chemotherapy

Abstract

Predicting the prognosis of unresectable pancreatic ductal adenocarcinoma (PDAC) is useful in determining the appropriate management strategy. The present study aimed to investigate the association between PDAC prognosis and inflammation-based markers, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, prognostic nutritional index, modified Glasgow prognostic score (mGPS) and controlling nutritional status score. A total of 72 patients with unresectable PDAC who received chemotherapy were included. Inflammation-based markers were measured prior to treatment. The median progression-free survival (PFS) and overall survival (OS) were 117 days (range, 10-781 days) and 244 days (range 43-781 days), respectively. The cut-off value of continuous variables that predicted the median OS (244 days) was calcualted. Univariate analysis of PFS showed that disease stage, first-line chemotherapy regimen, carcinoembryonic antigen (CEA), NLR, platelet-to-lymphocyte ratio (PLR), mGPS and controlling nutritional status (CONUT) scores were associated with PFS. Among them, stage, first-line chemotherapy regimen, CEA, NLR and mGPS were independent prognostic factors for PFS in multivariate analysis. Univariate analysis of OS showed that stage, first-line chemotherapy regimen, CA19-9, NLR, PLR, prognostic nutritional index (PNI), mGPS and CONUT score were associated wtih OS. Among them, first-line chemotherapy and mGPS were independent prognostic factors for OS according to multivariate analysis. Univariate and multivariate analyses revealed that a NLR ≥4.0 and mGPS 2 were independent prognostic factors for PFS. For OS, mGPS 2 was an independent prognostic factor. In conclusion, mGPS was the most useful marker in predicting the prognosis of patients with unresectable PDAC who received chemotherapy.

Dose Intensity/Body Surface Area Ratio is a Novel Marker Useful for Predicting Response to Lenvatinib against Hepatocellular Carcinoma

“…Interestingly, we also identified, for the first time, that the pretreatment nutritional status, which was measured by the CONUT score and BTR, was essential for achieving high 2M-DBR. The utility of the CONUT score in predicting the patient's prognosis treated with chemotherapy was reported in various types of gastrointestinal cancers [20][21][22]. Although there was no significant correlation between the CONUT score and PFS in lenvatinib treatment in our study (p = 0.1505), it may be worth reconsidering in a more extensive cohort study.…”

Peer Review #2 of "Predictive value of CONUT score combined with serum CA199 levels in postoperative survival of patients with pancreatic ductal adenocarcinoma: a retrospective study (v0.1)"

“…The CONUT score has been suggested as an indicator of immune-nutritional status of the Manuscript to be reviewed 2019a). Related studies have shown that the CONUT score is associated with survival prognosis of patients with unresectable PDAC and is an independent predictor of survival of patients with PDAC after pancreatectomy (Asama et al 2018;Kato et al 2018). Similar to previous reports, the finding of our report indicate that the preoperative CONUT score has value in predicting the postoperative prognosis of PADC patients.…”

Prognostic Significance of the Modified Glasgow Prognostic Score in Patients With Pancreatic Cancer: A Meta-Analysis

“…Finally, 26 studies were included in this meta-analysis. 15 - 40 The literature selection process is shown in Figure 1 . In the included studies, one study 18 recruited 2 independent cohorts of patients receiving chemotherapy or surgical resection, and the HRs and 95% CIs were separately given for these 2 cohorts.…”

“…The included studies were conducted in 8 countries, including Japan (n = 16), 20 - 22 , 24 , 25 , 27 , 29 - 32 , 35 - 40 China (n = 4), 17 , 23 , 26 , 28 Austria (n = 2 cohorts), 18 Australia (n = 1), 19 the United Kingdom (n = 1), 15 Greece (n = 1), 33 Italy (n = 1), 16 and Korea (n = 1). 34 A total of 24 studies with 4651 patients 15 - 17 , 19 - 34 , 36 - 40 provided data on the correlation between mGPS and OS. Seven cohorts presented the data on the prognostic value of mGPS for PFS, DFS, and CSS, including 3 for PFS, 29 , 30 , 38 2 for DFS, 31 , 35 and 2 for CSS.…”