THE ROLE OF IMMUNOINFLAMMATORY MARKERS IN THE PROGNOSIS AND RESECTABILITY OF PANCREATIC ADENOCARCINOMA

ABSTRACT Background: Pancreatic adenocarcinoma has a high mortality rate. A prognostic tool is essential for a better risk stratification. The neutrophil/lymphocyte ratio and adaptations and the platelet/lymphocyte ratio seem promising for this purpose. Aim: Evaluate the prognostic value of neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio and platelet/lymphocyte ratio, analyze the ideal cutoff values and investigate their utility in predicting resectability. Methods: Data were collected of patients with pancreatic adenocarcinoma in Hospital de Clínicas de Porto Alegre between 2003 and 2013. The studied ratios were determined by blood count collected at hospital admission and after two cycles of palliative chemotherapy. Results: Basal neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio and platelet/lymphocyte ratio did not have prognostic impact in survival (p=0.394, p=0.152, p=0.177 respectively). In subgroup analysis of patients submitted to palliative chemotherapy, neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio and platelet/lymphocyte ratio determined after two cycles of chemotherapy were prognostic for overall survival (p=0.003, p=0.009, p=0.001 respectively). The ideal cutoff values found were 4,11 for neutrophil/lymphocyte ratio (sensitivity 83%, specificity 75%), 2,8 for derived neutrophil/lymphocyte ratio (sensitivity 87%, specificity 62,5%) and 362 for platelet/lymphocyte ratio (sensitivity 91%, specificity 62,5%), Neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were not able to predict resectability (p=0.88; p=0.99; p=0.64 respectively). Conclusions: Neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio and platelet/lymphocyte ratio are useful as prognostic markers of overall survival in patients with pancreatic adenocarcinoma submitted to palliative chemotherapy. Its use as resectability predictor could not be demonstrated.

摘要 背景：胰腺导管腺癌（pancreatic adenocarcinoma）死亡率居高不下，精准的风险分层预后工具对临床诊疗至关重要。中性粒细胞/淋巴细胞比值（neutrophil/lymphocyte ratio）及其衍生形式、血小板/淋巴细胞比值（platelet/lymphocyte ratio）在该领域展现出良好的应用潜力。目的：评估中性粒细胞/淋巴细胞比值、衍生中性粒细胞/淋巴细胞比值（derived neutrophil/lymphocyte ratio）及血小板/淋巴细胞比值的预后价值，分析其最佳截断值，并探究三者在预测肿瘤可切除性方面的临床效用。方法：收集2003年至2013年于阿雷格里港临床医院（Hospital de Clínicas de Porto Alegre）收治的胰腺导管腺癌患者临床数据。研究涉及的各项比值通过患者入院时及接受两周期姑息化疗后的血常规检测结果计算得到。结果：基线状态下的中性粒细胞/淋巴细胞比值、衍生中性粒细胞/淋巴细胞比值及血小板/淋巴细胞比值对患者总生存期无显著预后影响（分别对应p=0.394、p=0.152、p=0.177）。在接受姑息化疗的患者亚组分析中，两周期化疗后检测得到的上述三项比值对总生存期具有显著预后价值（分别对应p=0.003、p=0.009、p=0.001）。本研究确定的最佳截断值为：中性粒细胞/淋巴细胞比值4.11（灵敏度83%，特异度75%）、衍生中性粒细胞/淋巴细胞比值2.8（灵敏度87%，特异度62.5%）、血小板/淋巴细胞比值362（灵敏度91%，特异度62.5%）。此外，上述三项比值均无法有效预测肿瘤可切除性（分别对应p=0.88、p=0.99、p=0.64）。结论：中性粒细胞/淋巴细胞比值、衍生中性粒细胞/淋巴细胞比值及血小板/淋巴细胞比值可作为接受姑息化疗的胰腺导管腺癌患者总生存期的预后标志物；本研究未证实三者可作为肿瘤可切除性的有效预测指标。