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21-03-2023 | Pancreatectomy | Original Article

A novel combined carbohydrate antigen 19-9 and lymphocyte-to-monocyte ratio score can predict early recurrence of resectable pancreatic ductal adenocarcinoma

Authors: Kyohei Yugawa, Takashi Maeda, Shigeyuki Nagata, Akihiro Sakai, Kenji Taketani, Shohei Yamaguchi, Kozo Konishi, Kenkichi Hashimoto

Published in: Surgery Today | Issue 10/2023

Abstract

Purpose

Pancreatic ductal adenocarcinoma (PDAC) often recurs early after radical resection, which causes a poor prognosis. This study aimed to establish a scoring model to assess the optimal treatment in patients who underwent surgery for PDAC.

Methods

This single-center retrospective study included 127 patients who underwent radical resection for PDAC between 2005 and 2021. Early recurrence (ER) was defined as recurrence within 12 months after resection. The predictive effect for ER was evaluated using receiver operating characteristic (ROC) curves of preoperative parameters.

Results

ER occurred in 43 (33.9%) patients. The ER group had a significantly worse prognosis than the non-ER group (p < 0.0001). The carbohydrate antigen 19-9 (CA19-9) level and lymphocyte-to-monocyte ratio (LMR) were the strongest diagnostic factors (areas under the ROC curves: 0.74 and 0.68, respectively). The ER prediction score was calculated using optimal cutoff values. A higher CA19-9-LMR score was associated with a worse prognosis in terms of the overall and recurrence-free survival (p = 0.0017 and p < 0.0001, respectively). A multivariate analysis identified a high CA19-9-LMR score as an independent predictor of ER.

Conclusions

The CA19-9-LMR scoring model can predict ER after surgery and is applicable for risk stratification in the assessment of patients with resectable PDAC.

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Katanoda K, Hori M, Saito E, Shibata A, Ito Y, Minami T, et al. Updated trends in Cancer in Japan: incidence in 1985–2015 and mortality in 1958–2018-a sign of decrease in Cancer incidence. J Epidemiol. 2021;31(7):426–50.CrossRefPubMedPubMedCentral

Rahib L, Wehner MR, Matrisian LM, Nead KT. Estimated projection of US cancer incidence and death to 2040. JAMA Netw Open. 2021;4(4): e214708.CrossRefPubMedPubMedCentral

Khorana A, Mangu P, Berlin J, Engebretson A, Hong T, Maitra A, et al. Potentially curable pancreatic cancer: American society of clinical oncology clinical practice guideline update. J Clin Oncol. 2017;35(20):2324–8.CrossRefPubMed

Groot VP, Rezaee N, Wu W, Cameron JL, Fishman EK, Hruban RH, et al. Patterns, timing, and predictors of recurrence following pancreatectomy for pancreatic ductal adenocarcinoma. Ann Surg. 2018;267(5):936–45.CrossRefPubMed

Shin SH, Kim SC, Song KB, Hwang DW, Lee JH, Park KM, et al. Chronologic changes in clinical and survival features of pancreatic ductal adenocarcinoma since 2000: a single-center experience with 2,029 patients. Surgery. 2018;164(3):432–42.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(11):1258–67.CrossRefPubMed

Sierzega M, Lenart M, Rutkowska M, Surman M, Mytar B, Matyja A, 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.CrossRefPubMed

Yu J, Ding Z, Yang Y, Liu S. Increased platelet-to-lymphocytes ratio is associated with poor long-term prognosis in patients with pancreatic cancer after surgery. Medicine (Baltimore). 2018;97(25): e11002.CrossRefPubMed

Haruki K, Shiba H, Shirai Y, Horiuchi T, Iwase R, Fujiwara Y, et al. The C-reactive protein to albumin ratio predicts long-term outcomes in patients with pancreatic cancer after pancreatic resection. World J Surg. 2016;40(9):2254–60.CrossRefPubMed

10.

Itoh S, Tsujita E, Fukuzawa K, Sugimachi K, Iguchi T, Ninomiya M, et al. Prognostic significance of preoperative PNI and CA19-9 for pancreatic ductal adenocarcinoma: a multi-institutional retrospective study. Pancreatology. 2021;21(7):1356–63.CrossRefPubMed

11.

Tempero MA, Malafa MP, Al-Hawary M, Asbun H, Bain A, Behrman SW, et al. Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017;15(8):1028–61.

12.

Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, 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(3):584–91.CrossRefPubMed

13.

Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. John Wiley & Sons. 2017.

14.

Motoi F, Kosuge T, Ueno H, Yamaue H, Satoi S, Sho M, et al. Randomized phase II/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02/JSAP05). Jpn J Clin Oncol. 2019;49(2):190–4.CrossRefPubMed

15.

Ruopp M, Perkins N, Whitcomb B, Schisterman E. Youden Index and optimal cut-point estimated from observations affected by a lower limit of detection. Biom J. 2008;50(3):419–30.CrossRefPubMedPubMedCentral

16.

Sugiura T, Uesaka K, Kanemoto H, Mizuno T, Sasaki K, Furukawa H, et al. Serum CA19-9 is a significant predictor among preoperative parameters for early recurrence after resection of pancreatic adenocarcinoma. J Gastrointest Surg. 2012;16(5):977–85.CrossRefPubMed

17.

Matsumoto I, Murakami Y, Shinzeki M, Asari S, Goto T, Tani M, et al. Proposed preoperative risk factors for early recurrence in patients with resectable pancreatic ductal adenocarcinoma after surgical resection: a multi-center retrospective study. Pancreatology. 2015;15(6):674–80.CrossRefPubMed

18.

Ishido K, Kimura N, Wakiya T, Nagase H, Hara Y, Kanda T, et al. Development of a biomarker-based scoring system predicting early recurrence of resectable pancreatic duct adenocarcinoma. Ann Surg Oncol. 2022;29(2):1281–93.CrossRefPubMed

19.

Yamamoto Y, Ikoma H, Morimura R, Konishi H, Murayama Y, Komatsu S, et al. Optimal duration of the early and late recurrence of pancreatic cancer after pancreatectomy based on the difference in the prognosis. Pancreatology. 2014;14(6):524–9.CrossRefPubMed

20.

Nishio K, Kimura K, Amano R, Yamazoe S, Ohrira G, Nakata B, et al. Preoperative predictors for early recurrence of resectable pancreatic cancer. World J Surg Oncol. 2017;15(1):16.CrossRefPubMedPubMedCentral

21.

Groot VP, Gemenetzis G, Blair AB, Rivero-Soto RJ, Yu J, Javed AA, et al. Defining and predicting early recurrence in 957 patients with resected pancreatic ductal adenocarcinoma. Ann Surg. 2019;269(6):1154–62.CrossRefPubMed

22.

Kim TH, Han SS, Park SJ, Lee WJ, Woo SM, Yoo T, et al. CA 19-9 level as indicator of early distant metastasis and therapeutic selection in resected pancreatic cancer. Int J Radiat Oncol Biol Phys. 2011;81(5):e743–8.CrossRefPubMed

23.

Pointer DT Jr, Roife D, Powers BD, Murimwa G, Elessawy S, Thompson ZJ, et al. Neutrophil to lymphocyte ratio, not platelet to lymphocyte or lymphocyte to monocyte ratio, is predictive of patient survival after resection of early-stage pancreatic ductal adenocarcinoma. BMC Cancer. 2020;20(1):750.CrossRefPubMedPubMedCentral

24.

Liu Z, Jin K, Guo M, Long J, Liu L, Liu C, et al. Prognostic value of the CRP/Alb ratio, a novel inflammation-based score in pancreatic cancer. Ann Surg Oncol. 2017;24(2):561–8.CrossRefPubMed

25.

Kawai M, Hirono S, Okada KI, Miyazawa M, Shimizu A, Kitahata Y, et al. Low lymphocyte monocyte ratio after neoadjuvant therapy predicts poor survival after pancreatectomy in patients with borderline resectable pancreatic cancer. Surgery. 2019;165(6):1151–60.CrossRefPubMed

26.

Kubota K, Shimizu A, Notake T, Masuo H, Hosoda K, Yasukawa K, et al. Preoperative peripheral blood lymphocyte-to-monocyte ratio predicts long-term outcome for patients with pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2022;29(2):1437–48.CrossRefPubMed

27.

Guo SW, Shen J, Gao JH, Shi XH, Gao SZ, Wang H, et al. A preoperative risk model for early recurrence after radical resection may facilitate initial treatment decisions concerning the use of neoadjuvant therapy for patients with pancreatic ductal adenocarcinoma. Surgery. 2020;168(6):1003–14.CrossRefPubMed

28.

Ikuta S, Sonoda T, Aihara T, Yamanaka N. A combination of platelet-to-lymphocyte ratio and carbohydrate antigen 19-9 predict early recurrence after resection of pancreatic ductal adenocarcinoma. Ann Transl Med. 2019;7(18):461.CrossRefPubMedPubMedCentral

29.

Murakami T, Hiroshima Y, Matsuyama R, Homma Y, Hoffman RM, Endo I. Role of the tumor microenvironment in pancreatic cancer. Ann Gastroenterol Surg. 2019;3(2):130–7.CrossRefPubMedPubMedCentral

30.

Yugawa K, Itoh S, Yoshizumi T, Morinaga A, Iseda N, Toshima T, et al. Lymphocyte-C-reactive protein ratio as a prognostic marker associated with the tumor immune microenvironment in intrahepatic cholangiocarcinoma. Int J Clin Oncol. 2021;26(10):1901–10.CrossRefPubMed

31.

Itoh S, Yugawa K, Shimokawa M, Yoshiya S, Mano Y, Takeishi K, et al. Prognostic significance of inflammatory biomarkers in hepatocellular carcinoma following hepatic resection. BJS Open. 2019;3(4):500–8.PubMedPubMedCentral

32.

Zhan HX, Xu JW, Wu D, Wu ZY, Wang L, Hu SY, et al. Neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of prospective studies. Cancer Med. 2017;6(6):1201–19.CrossRefPubMedPubMedCentral

33.

Kim JS, Choi M, Kim SH, Hwang HK, Lee WJ, Kang CM. Systemic inflammation response index correlates with survival and predicts oncological outcome of resected pancreatic cancer following neoadjuvant chemotherapy. Pancreatology. 2022;22(7):987–93.CrossRefPubMed

Title: A novel combined carbohydrate antigen 19-9 and lymphocyte-to-monocyte ratio score can predict early recurrence of resectable pancreatic ductal adenocarcinoma
Authors: Kyohei Yugawa
Takashi Maeda
Shigeyuki Nagata
Akihiro Sakai
Kenji Taketani
Shohei Yamaguchi
Kozo Konishi
Kenkichi Hashimoto
Publication date: 21-03-2023
Publisher: Springer Nature Singapore
Keyword: Pancreatectomy
Published in: Surgery Today / Issue 10/2023
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-023-02675-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A novel combined carbohydrate antigen 19-9 and lymphocyte-to-monocyte ratio score can predict early recurrence of resectable pancreatic ductal adenocarcinoma

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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