Top

Published in:

01-12-2018 | Pancreatic Tumors

Prognostic Value of Preoperative Nutritional and Immunological Factors in Patients with Pancreatic Ductal Adenocarcinoma

Authors: Toshiya Abe, MD, PhD, Kohei Nakata, MD, PhD, Shin Kibe, MD, Yasuhisa Mori, MD, PhD, Yoshihiro Miyasaka, MD, PhD, Kenoki Ohuchida, MD, PhD, Takao Ohtsuka, MD, PhD, Yoshinao Oda, MD, PhD, Masafumi Nakamura, MD, PhD

Published in: Annals of Surgical Oncology | Issue 13/2018

Abstract

Background

Preoperative nutritional and immunological patient factors have been found to be associated with prognostic outcomes of malignant tumors; however, the clinical significance of these factors in pancreatic ductal adenocarcinoma (PDAC) remains controversial.

Objective

The aim of this study was to evaluate the prognostic value of nutritional and immunological factors in predicting survival of patients with PDAC.

Methods

Retrospective studies of 329 patients who underwent surgical resection for PDAC and 95 patients who underwent palliative surgery were separately conducted to investigate the prognostic impact of tumor-related factors and patient-related factors, including Glasgow Prognostic Score (GPS), modified GPS, Prognostic Nutritional Index (PNI), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, and lymphocyte/monocyte ratio.

Results

In multivariate analysis for patients with surgical resection for PDAC, PNI was an independent factor for overall survival (OS) and disease-free survival. The median OS of patients with PNI ≤ 45 was significantly shorter than that of patients with PNI > 45 (17.5 and 36.2 months, respectively; p < 0.001). In multivariate analysis for patients undergoing palliative surgery for PDAC, only NLR was an independent prognosis factor. The median OS of patients with NLR > 5 was significantly shorter than that of patients with NLR ≤ 5 (2.7 and 8.9 months, respectively; p < 0.001).

Conclusions

PNI in patients with surgical resection and NLR in patients with palliative surgery for PDAC may be useful prognostic factors.

Available only for authorised users

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30. http://doi.org/10.3322/caac.21442.CrossRefPubMed

Conlon KC, Klimstra DS, Brennan MF. Long-term survival after curative resection for pancreatic ductal adenocarcinoma. Clinicopathologic analysis of 5-year survivors. Ann Surg. 1996;223(3):273–9. http://doi.org/10.1097/00000658-199603000-00007.CrossRefPubMedPubMedCentral

Brennan M, Kattan M, Klimstra D, Conlon K. Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg. 2004;240(2):293–8. http://doi.org/10.1097/01.sla.0000133125.85489.07.CrossRefPubMedPubMedCentral

Vakkila J, Lotze MT. Opinion: Inflammation and necrosis promote tumour growth. Nat Rev Immunol. 2004;4(8):641–8. http://doi.org/10.1038/nri1415.CrossRefPubMed

Ben Q, An W, Wang L, Wang W, Yu L, Yuan Y. Validation of the pretreatment neutrophil-lymphocyte ratio as a predictor of overall survival in a cohort of patients with pancreatic ductal adenocarcinoma. Pancreas. 2015;44(3):471–7. http://doi.org/10.1097/MPA.0000000000000271.CrossRefPubMed

Jamieson NB, Denley SM, Logue J, et al. A prospective comparison of the prognostic value of tumor- and patient-related factors in patients undergoing potentially curative surgery for pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2011;18(8):2318–28. http://doi.org/10.1245/s10434-011-1560-3.CrossRefPubMed

La Torre M, Nigri G, Cavallini M, Mercantini P, Ziparo V, Ramacciato G. The glasgow prognostic score as a predictor of survival in patients with potentially resectable pancreatic adenocarcinoma. Ann Surg Oncol. 2012;19(9):2917–23. http://doi.org/10.1245/s10434-012-2348-9.CrossRefPubMed

Sierzega M, Lenart M, Rutkowska M, et al. Preoperative Neutrophil-Lymphocyte and Lymphocyte-Monocyte Ratios Reflect Immune Cell Population Rearrangement in Resectable Pancreatic Cancer. Ann Surg Oncol. 2017;24(3):808–15. http://doi.org/10.1245/s10434-016-5634-0.CrossRefPubMed

Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg. 2011;98(2):268–74. http://doi.org/10.1002/bjs.7305.CrossRefPubMed

10.

Sugiura T, Uesaka K, Kanemoto H, Mizuno T, Okamura Y. Elevated Preoperative neutrophil-to-lymphocyte ratio as a predictor of survival after gastroenterostomy in patients with advanced pancreatic adenocarcinoma. Ann Surg Oncol. 2013;20(13):4330–7. http://doi.org/10.1245/s10434-013-3227-8.CrossRefPubMed

11.

Abe T, Ohuchida K, Endo S, et al. Clinical importance of intraoperative peritoneal cytology in patients with pancreatic cancer. Surg (United States). 2017;161(4):951–8. http://doi.org/10.1016/j.surg.2016.10.035.CrossRef

12.

McMillan DC, Elahi MM, Sattar N, Angerson WJ, Johnstone J, McArdle CS. Measurement of the systemic inflammatory response predicts cancer-specific and non-cancer survival in patients with cancer. Nutr Cancer. 2001;41(1–2):64–9. http://doi.org/10.1080/01635581.2001.9680613.CrossRefPubMed

13.

McMillan DC, Crozier JEM, Canna K, Angerson WJ, McArdle CS. Evaluation of an inflammation-based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer. Int J Colorectal Dis. 2007;22(8):881–6. http://doi.org/10.1007/s00384-006-0259-6.CrossRefPubMed

14.

Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients [in Japanese]. Nippon Geka Gakkai Zasshi. 1984;85:1001–5.PubMed

15.

Shirai Y, Shiba H, Sakamoto T, et al. Preoperative platelet to lymphocyte ratio predicts outcome of patients with pancreatic ductal adenocarcinoma after pancreatic resection. Surgery. 2015;158(2):360–5. http://doi.org/10.1016/j.surg.2015.03.043.CrossRefPubMed

16.

Wang DS, Luo HY, Qiu MZ, et al. Comparison of the prognostic values of various inflammation based factors in patients with pancreatic cancer. Med Oncol. 2012;29(5):3092–100. http://doi.org/10.1007/s12032-012-0226-8.CrossRefPubMed

17.

Lee SH, Chung MJ, Kim B, et al. The significance of the prognostic nutritional index for all stages of pancreatic cancer. Nutr Cancer. 2017;69(3):512–9. http://doi.org/10.1080/01635581.2016.1250921.CrossRefPubMed

18.

Stotz M, Gerger A, Eisner F, et al. Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer. Br J Cancer. 2013;109(2):416–21. http://doi.org/10.1038/bjc.2013.332.CrossRefPubMedPubMedCentral

19.

Ray-Coquard I, Cropet C, Van Glabbeke M, et al. Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas. Cancer Res. 2009;69(13):5383–91. http://doi.org/10.1158/0008-5472.CAN-08-3845.CrossRefPubMedPubMedCentral

20.

Laky B, Janda M, Bauer J, Vavra C, Cleghorn G, Obermair A. Malnutrition among gynaecological cancer patients. Eur J Clin Nutr. 2007;61(5):642–6. http://doi.org/10.1038/sj.ejcn.1602540.CrossRefPubMed

21.

Nozoe T, Kohno M, Iguchi T, et al. The prognostic nutritional index can be a prognostic indicator in colorectal carcinoma. Surg Today. 2012;42(6):532–5. http://doi.org/10.1007/s00595-011-0061-0.CrossRefPubMed

22.

Nozoe T, Ninomiya M, Maeda T, Matsukuma A, Nakashima H, Ezaki T. Prognostic nutritional index: A tool to predict the biological aggressiveness of gastric carcinoma. Surg Today. 2010;40(5):440–3. http://doi.org/10.1007/s00595-009-4065-y.CrossRefPubMed

23.

Kanda M, Mizuno A, Tanaka C, et al. Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer. Med (Baltimore). 2016;95(24):e3781. http://doi.org/10.1097/MD.0000000000003781.CrossRefPubMedCentral

24.

Martin L, Birdsell L, MacDonald N, et al. Cancer cachexia in the age of obesity: Skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539–47. http://doi.org/10.1200/JCO.2012.45.2722.CrossRefPubMed

25.

Okumura S, Kaido T, Hamaguchi Y, et al. Impact of preoperative quality as well as quantity of skeletal muscle on survival after resection of pancreatic cancer. Surg (United States). 2015;157(6):1088–1098. http://doi.org/10.1016/j.surg.2015.02.002.CrossRef

Title: Prognostic Value of Preoperative Nutritional and Immunological Factors in Patients with Pancreatic Ductal Adenocarcinoma
Authors: Toshiya Abe, MD, PhD
Kohei Nakata, MD, PhD
Shin Kibe, MD
Yasuhisa Mori, MD, PhD
Yoshihiro Miyasaka, MD, PhD
Kenoki Ohuchida, MD, PhD
Takao Ohtsuka, MD, PhD
Yoshinao Oda, MD, PhD
Masafumi Nakamura, MD, PhD
Publication date: 01-12-2018
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 13/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-018-6761-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Prognostic Value of Preoperative Nutritional and Immunological Factors in Patients with Pancreatic Ductal Adenocarcinoma

Abstract

Background

Objective

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 13/2018

Clinical Implications of Extensive Lymph Node Metastases for Resected Pancreatic Cancer

A Novel Navigation for Laparoscopic Anatomic Liver Resection Using Indocyanine Green Fluorescence

Total Laparoscopic Pancreaticoduodenectomy with Venous Reconstruction for Pancreatic Head Cancer with Involvement of the Superior Mesenteric Vein–Portal Vein Confluence

Both Ultrasound Features and Nuclear Atypia are Associated with Malignancy in Thyroid Nodules with Atypia of Undetermined Significance

Lymph Node Micrometastasis Prognosticates Survival for Patients with Stage 1 Bronchogenic Adenocarcinoma

Expanding with Air: Proceed with Caution