Top

Published in:

24-07-2023 | Cytostatic Therapy | Original Article

The postoperative platelet-to-lymphocyte ratio predicts the outcome of patients undergoing pancreaticoduodenectomy for pancreatic head cancer

Authors: Yoshihiro Shirai, Ryoga Hamura, Yoshiaki Tanji, Tomohiko Taniai, Mitsuru Yanagaki, Koichiro Haruki, Kenei Furukawa, Shinji Onda, Taro Sakamoto, Takeshi Gocho, Toru Ikegami

Published in: Surgery Today | Issue 3/2024

Abstract

Purpose

The preoperative platelet-to-lymphocyte ratio (PLR) has been reported as an important prognostic index for pancreatic ductal adenocarcinoma (PDAC); however, the significance of the postoperative (post-op) PLR for this disease has not been elucidated.

Methods

We analyzed data on 118 patients who underwent pancreaticoduodenectomy for pancreatic head PDAC, collected from a prospectively maintained database. The post-op PLR was obtained by dividing the platelet count after surgery by the lymphocyte count on post-op day (POD) 14. The patients were divided into two groups according to a post-op PLR of < 310 or ≥ 310. Survival data were analyzed.

Results

A high post-op PLR was identified as a significant prognostic index on univariate analysis for disease-free survival (DFS) and overall survival (OS). The post-op PLR remained significant, along with tumor differentiation and adjuvant chemotherapy, on multivariate analysis for OS (hazard ratio = 2.077, 95% confidence interval: 1.220–3.537; p = 0.007). The post-op PLR was a significant independent prognostic index for poor DFS, along with tumor differentiation and lymphatic invasion, on multivariate analysis (hazard ratio = 1.678, 95% confidence interval: 1.056–2.667; p = 0.028).

Conclusions

The post-op PLR in patients with pancreatic head PDAC was an independent predictor of DFS and OS after elective resection.

Available only for authorised users

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2000;71:209–49.CrossRef

Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013;310:1473–81.CrossRefPubMed

Conroy T, Hammel P, Hebbar M, Abdelghani MB, Wei AC, Raoul JL, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med. 2018;379:2395–406.CrossRefPubMed

Sakaguchi T, Satoi S, Yamamoto T, Yamaki S, Sekimoto M. The past, present, and future status of multimodality treatment for resectable/borderline resectable pancreatic ductal adenocarcinoma. Surg Today. 2020;50(4):335–43.CrossRefPubMedPubMedCentral

Gall TMH, Jacob J, Frampton AE, Krell J, Kyriakides C, Castellano L, et al. Reduced dissemination of circulating tumor cells with no-touch isolation surgical technique in patients with pancreatic cancer. JAMA Surg. 2014;149:482–5.CrossRefPubMed

Nierodzik ML, Plotkin A, Kajumo F, Karpatkin S. Thrombin stimulates tumor-platelet adhesion in vitro and metastasis in vivo. J Clin Invest. 1991;87:229–36.CrossRefPubMedPubMedCentral

Shirai Y, Shiba H, Sakamoto T, Horiuchi K, Haruki K, Fujiwara Y, et al. Preoperative platelet to lymphocyte ratio predicts outcome of patients with pancreatic ductal adenocarcinoma after pancreatic resection. Surgery. 2015;158:360–5.CrossRefPubMed

Shirai Y, Shiba H, Haruki K, Horiuchi T, Saito N, Fujiwara Y, et al. Preoperative platelet-to-albumin ratio predicts prognosis of patients with pancreatic ductal adenocarcinoma after pancreatic resection. Anticancer Res. 2017;37:787–93.CrossRefPubMed

Watanabe J, Otani S, Sakamoto T, Arai Y, Hanaki T, Amisaki M, et al. Prognostic indicators based on inflammatory and nutritional factors after pancreaticoduodenectomy for pancreatic cancer. Surg Today. 2016;46:1258–67.CrossRefPubMed

10.

Asari S, Matsumoto I, Toyama H, Shinzeki M, Goto T, Ishida J, et al. Preoperative independent prognostic factors in patients with borderline resectable pancreatic ductal adenocarcinoma following curative resection: the neutrophil-lymphocyte and platelet-lymphocyte ratios. Surg Today. 2016;46:583–92.CrossRefPubMed

11.

Bong TSH, Tan GHC, Chia C, Soo KC, Teo MCC. Preoperative platelet-lymphocyte ratio is an independent prognostic marker and superior to carcinoembryonic antigen in colorectal peritoneal carcinomatosis patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Int J Clin Oncol. 2017;22:511–8.CrossRefPubMed

12.

Kakita A, Takahashi T, Yoshida M, Furuta K. A simpler and more reliable technique of pancreatojejunal anastomosis. Surg Today. 1996;26:532–5.CrossRefPubMed

13.

Fujii T, Sugimoto H, Yamada S, Kanda M, Suenaga M, Takami H, et al. Modified Blumgart anastomosis for pancreaticojejunostomy: technical improvement in matched historical control study. J Gastrointest Surg. 2014;18:1108–15.CrossRefPubMed

14.

Brierley DJ GK, Wittekind C. TNM Classification of Malignant Tumor, 8th edition. Wiley-Blackwell. 2017.

15.

Bassi C, Marchegiani G, Dervenis C, Sarr M, Hilal MA, Adham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161:584–91.CrossRefPubMed

16.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral

17.

Alexandrakis MG, Passam FH, Moschandrea IA, Christophoridou AV, Pappa CA, Coulocheri SA, et al. Levels of serum cytokines and acute phase proteins in patients with essential and cancer-related thrombocytosis. Am J Clin Oncol. 2003;26:135–40.CrossRefPubMed

18.

Ivert T, Dalén M, Ander C, Stålesen R, Lordkipanidzé M, Hjemdahl P, et al. Increased platelet reactivity and platelet-leukocyte aggregation after elective coronary bypass surgery. Platelets. 2019;30:975–81.CrossRefPubMed

19.

Pugalenthi A, Protic M, Gonen M, Kingham TP, D’Angelica MI, Dematteo RP, et al. Postoperative complications and overall survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. J Surg Oncol. 2016;113:188–93.CrossRefPubMed

20.

Aoyama T, Murakawa M, Katayama Y, Yamaoku K, Kanazawa A, Higuchi A, et al. Impact of postoperative complications on survival and recurrence in pancreatic cancer. Anticancer Res. 2015;35:2401–9.PubMed

21.

Wojtukiewicz MZ, Sierko E, Hempel D, Tucker SC, Honn KV. Platelets and cancer angiogenesis nexus. Cancer Metastasis Rev. 2017;36:249–62.CrossRefPubMedPubMedCentral

22.

Goubran HA, Stakiw J, Radosevic M, Burnouf T. Platelets effects on tumor growth. Semin Oncol. 2014;41:359–69.CrossRefPubMed

23.

Bastida E, Almirall L, Ordinas A. Tumor-cell-induced platelet aggregation is a glycoprotein-dependent and lipoxygenase-associated process. Int J Cancer. 1987;39:760–3.CrossRefPubMed

24.

Amo L, Tamayo-Orbegozo E, Maruri N, Eguizabal C, Zenarruzabeitia O, Riñón M, et al. Involvement of platelet-tumor cell interaction in immune evasion. Potential role of podocalyxin-like protein 1. Frontier Oncol. 2014;4:245.

25.

Quail DF, Joyce JA. Microenvironmental regulation of tumor progression and metastasis. Nat Med. 2013;19:1423–37.CrossRefPubMedPubMedCentral

26.

Miyashita T, Tajima H, Makino I, Nakagawa H, Kitagawa H, Fushida S, et al. Metastasis-promoting role of extravasated platelet activation in tumor. J Surg Res. 2015;193:289–94.CrossRefPubMed

27.

Okazaki M, Yamaguchi T, Tajima H, Fushida S, Ohta T. Platelet adherence to cancer cells promotes escape from innate immune surveillance in cancer metastasis. Int J Oncol. 2020;57:980–8.PubMed

28.

Ishikawa M, Nishioka M, Hanaki N, Miyauchi T, Kashiwagi Y, Ioki H, et al. Perioperative immune responses in cancer patients undergoing digestive surgeries. World J Surg Oncol. 2009;7:7.CrossRefPubMedPubMedCentral

29.

Yang MW, Tao LY, Jiang YS, Yang JY, Huo YM, Liu DJ, et al. Perineural invasion reprograms the immune microenvironment through cholinergic signaling in pancreatic ductal adenocarcinoma. Cancer Res. 2020;80:1991–2003.CrossRefPubMed

30.

Uesaka K, Boku N, Fukutomi A, Okamura Y, Konishi M, Matsumoto I, et al. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet. 2016;388:248–57.CrossRefPubMed

31.

Rothwell PM, Wilson M, Price JF, Belch JF, Meade TW, Mehta Z. Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials. Lancet. 2012;379:1591–601.CrossRefPubMed

32.

Khalaf N, Yuan C, Hamada T, Cao Y, Babic A, Morales-Oyarvide V, et al. Regular use of aspirin or non-aspirin nonsteroidal anti-inflammatory drugs is not associated with risk of incident pancreatic cancer in two large cohort studies. Gastroenterology. 2018;154:1380-90.e5.CrossRefPubMed

33.

Coyle C, Cafferty FH, Rowley S, MacKenzie M, Berkman L, Gupta S, et al. ADD-ASPIRIN: A phase III, double-blind, placebo controlled, randomised trial assessing the effects of aspirin on disease recurrence and survival after primary therapy in common non-metastatic solid tumours. Contemp Clin Trial. 2016;51:56–64.CrossRef

34.

Pretzsch E, D’Haese JG, Renz B, Ilmer M, Schiergens T, Miksch RC, et al. Effect of platelet inhibition with perioperative aspirin on survival in patients undergoing curative resection for pancreatic cancer: a propensity score matched analysis. BMC Surg. 2021;21:98.CrossRefPubMedPubMedCentral

Title: The postoperative platelet-to-lymphocyte ratio predicts the outcome of patients undergoing pancreaticoduodenectomy for pancreatic head cancer
Authors: Yoshihiro Shirai
Ryoga Hamura
Yoshiaki Tanji
Tomohiko Taniai
Mitsuru Yanagaki
Koichiro Haruki
Kenei Furukawa
Shinji Onda
Taro Sakamoto
Takeshi Gocho
Toru Ikegami
Publication date: 24-07-2023
Publisher: Springer Nature Singapore
Keyword: Cytostatic Therapy
Published in: Surgery Today / Issue 3/2024
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-023-02727-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The postoperative platelet-to-lymphocyte ratio predicts the outcome of patients undergoing pancreaticoduodenectomy for pancreatic head cancer

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2024

Prognostic significance of the cachexia index in patients with unresectable advanced gastric cancer receiving palliative chemotherapy: a retrospective single-center study

Could the molecular profile help predict occult nodal metastasis in early-stage lung adenocarcinoma?

Learning process analysis of robotic lateral pelvic lymph node dissection for local advanced rectal cancer: the CUSUM curve of 78 consecutive patients

Could the molecular profile aid in predicting occult nodal metastasis in early-stage lung adenocarcinoma?

“Role-sharing surgery”: a new surgical education system that gives beginner surgeons more chances to operate while ensuring the surgical quality of robotic surgery

Update on aortopexy and posterior tracheopexy for tracheomalacia in patients with esophageal atresia