Low lymphocyte monocyte ratio after neoadjuvant therapy predicts poor survival after pancreatectomy in patients with borderline resectable pancreatic cancer.
Aged
Aged, 80 and over
Antineoplastic Agents
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Biomarkers, Tumor
/ blood
Carcinoma, Pancreatic Ductal
/ immunology
Chemoradiotherapy, Adjuvant
Databases, Factual
Female
Follow-Up Studies
Humans
Lymphocyte Count
Lymphocytes
/ metabolism
Male
Middle Aged
Monocytes
/ metabolism
Neoadjuvant Therapy
Pancreatectomy
/ mortality
Pancreatic Neoplasms
/ immunology
Prognosis
Retrospective Studies
Survival Analysis
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
20
09
2018
revised:
10
12
2018
accepted:
21
12
2018
pubmed:
16
2
2019
medline:
4
1
2020
entrez:
16
2
2019
Statut:
ppublish
Résumé
The impact of systemic immune inflammatory markers to predict survival in patients receiving neoadjuvant therapy for borderline resectable pancreatic cancer has not been sufficiently investigated. This study aims to evaluate whether systemic immune inflammatory markers after neoadjuvant therapy followed by pancreatectomy become preoperative prognostic factors to predict survival in patients with borderline resectable pancreatic cancer. We retrospectively reviewed 67 borderline resectable pancreatic cancer patients receiving neoadjuvant therapy and 58 borderline resectable pancreatic cancer patients undergoing upfront surgery between 2010 and 2016. The association between survival and systemic immune inflammatory markers was evaluated by univariate and multivariate analysis. The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and prognostic nutrition index were assessed as systemic immune inflammatory markers. In univariate analysis, the postneoadjuvant neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and prognostic nutrition index are significantly associated with survival as systemic immune inflammatory markers. The optimal cutoff value of the postneoadjuvant neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and prognostic nutrition index were 2.5, 3.0, and 45, respectively. Patients with a lymphocyte-to-monocyte ratio <3.0 had significantly poor survival compared with those who had a lymphocyte-to-monocyte ratio ≥3.0 (14.9 months vs 31.7 months, P = .006). The multivariate analysis identified the following as predictors of poor prognosis: postneoadjuvant lymphocyte-to-monocyte ratio <3.0 (HR 2.59; 95% CI 1.02-6.58; P = .045), T4 (HR 1.82; 95% CI 1.11-3.01; P = .029), lymph node status (HR 2.62; 95% CI 1.24-5.51; P = .012), and no completion of adjuvant therapy (HR 7.09; 95% CI 3.08-16.4; P < .001). A low lymphocyte-to-monocyte ratio after neoadjuvant therapy is useful prognostic information for patients with borderline resectable pancreatic cancer. This result might indicate a potential role of lymphocyte-to-monocyte ratios in stratification of treatment strategy in borderline resectable pancreatic cancer patients.
Sections du résumé
BACKGROUND
The impact of systemic immune inflammatory markers to predict survival in patients receiving neoadjuvant therapy for borderline resectable pancreatic cancer has not been sufficiently investigated. This study aims to evaluate whether systemic immune inflammatory markers after neoadjuvant therapy followed by pancreatectomy become preoperative prognostic factors to predict survival in patients with borderline resectable pancreatic cancer.
METHODS
We retrospectively reviewed 67 borderline resectable pancreatic cancer patients receiving neoadjuvant therapy and 58 borderline resectable pancreatic cancer patients undergoing upfront surgery between 2010 and 2016. The association between survival and systemic immune inflammatory markers was evaluated by univariate and multivariate analysis. The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and prognostic nutrition index were assessed as systemic immune inflammatory markers.
RESULTS
In univariate analysis, the postneoadjuvant neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and prognostic nutrition index are significantly associated with survival as systemic immune inflammatory markers. The optimal cutoff value of the postneoadjuvant neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and prognostic nutrition index were 2.5, 3.0, and 45, respectively. Patients with a lymphocyte-to-monocyte ratio <3.0 had significantly poor survival compared with those who had a lymphocyte-to-monocyte ratio ≥3.0 (14.9 months vs 31.7 months, P = .006). The multivariate analysis identified the following as predictors of poor prognosis: postneoadjuvant lymphocyte-to-monocyte ratio <3.0 (HR 2.59; 95% CI 1.02-6.58; P = .045), T4 (HR 1.82; 95% CI 1.11-3.01; P = .029), lymph node status (HR 2.62; 95% CI 1.24-5.51; P = .012), and no completion of adjuvant therapy (HR 7.09; 95% CI 3.08-16.4; P < .001).
CONCLUSION
A low lymphocyte-to-monocyte ratio after neoadjuvant therapy is useful prognostic information for patients with borderline resectable pancreatic cancer. This result might indicate a potential role of lymphocyte-to-monocyte ratios in stratification of treatment strategy in borderline resectable pancreatic cancer patients.
Identifiants
pubmed: 30765142
pii: S0039-6060(18)30844-4
doi: 10.1016/j.surg.2018.12.015
pii:
doi:
Substances chimiques
Antineoplastic Agents
0
Biomarkers, Tumor
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1151-1160Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.