Prognostic Nutritional Index after Chemoradiotherapy Was the Strongest Prognostic Predictor among Biological and Conditional Factors in Localized Pancreatic Ductal Adenocarcinoma Patients

Abstract

Background: In many malignancies, including pancreatic ductal adenocarcinoma (PDAC), host-related inflammatory/immunonutritional markers, such as the prognostic nutritional index (PNI), modified Glasgow prognostic score (mGPS), and C-reactive protein (CRP)/albumin ratio are reported to be prognostic factors. However, the prognostic influence of these factors before and after chemoradiotherapy (CRT) has not been studied in PDAC patients. Methods: Of 261 consecutive PDAC patients who were scheduled for CRT with gemcitabine or S1 plus gemcitabine between February 2005 and December 2015, participants in this study were 176 who completed CRT and had full data available on inflammatory/immunonutritional markers as well as on anatomical and biological factors for the investigation of prognostic/predictive factors. Results: In multivariate analysis, the significant prognostic factors were RECIST classification, cT category, performance status, post-CRT carcinoembryonic antigen, post-CRT C-reactive protein/albumin ratio, post-CRT mGPS, and post-CRT PNI. Post-CRT PNI (cut-off value, 39) was the strongest host-related prognostic factor according to the p-value. In the patients who underwent resection after CRT, median survival time (MST) was significantly shorter in the 12 patients with low PNI (<39) than in the 97 with high PNI (≥39), at 15.5 months versus 27.2 months, respectively (p = 0.0016). In the patients who did not undergo resection, MST was only 8.9 months in those with low PNI and 12.3 months in those with high PNI (p < 0.0001), and thus was similar to that of the resected patients with low PNI. Conclusions: Post-CRT PNI was the strongest prognostic/predictive indicator among the independent biological and conditional prognostic factors in PDAC patients who underwent CRT.

The prognostic value of modified Glasgow Prognostic Score in pancreatic cancer: a meta-analysis

“…Moreover, these cytokines, including tumor necrosis factor (TNF), increase the transcapillary passage of albumin as well as the permeability of the microvasculature. As a consequence, serum levels of albumin will drop [ 50 ]. Fleck’s group has demonstrated an elevated albumin transcapillary escape rate in patients with either sepsis or cancer [ 51 ].…”

Prognostic Value of Clinical Biochemistry-Based Indexes in Nasopharyngeal Carcinoma

“…Liu et al reported that inflammatory and nutritional markers were independent predictive indexes for the survival of gastric cancer patients (14). Combined indexes of inflammation and nutrition, such as PNI (18,32), SIS (22,33), and AGR (16,34) have been proved to be related to survival in cancers. Consistently, our study suggested that low level of PNI and AGR and high level of SIS had poor OS and DFS in NPC patients.…”

“…The clinical biochemistry-based indexes, such as prognostic nutritional index (PNI), albumin-to-alkaline phosphatase ratio (AAPR), albumin/globulin ratio (AGR), albumin (ALB), serum urea nitrogen (BUN) and creatinine (CREA) have been considered as independent prognostic factors for many cancers (15)(16)(17)(18)(19)(20)(21). The systemic inflammation score (SIS), based on the serum albumin level and LMR, has shown a better predictive effect on the prognosis of cancer compared to the single index (22).…”

The Prognostic Value of Modified Glasgow Prognostic Score in Pancreatic Cancer: A Meta-analysis

“…Actually, the mGPS calculated by serum level of CRP and albumin could provide more accurate and comprehensive prognostic information than CRP alone [50,53]. Furthermore, a prognostic tool such as the mGPS is more reliable and reproducible.…”