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Inflammatory biomarkers in patients with advanced pancreatic adenocarcinoma undergoing first-line chemotherapy with nab-paclitaxel and gemcitabine: A single-center study
Background
The aim of the study was to examine the prognostic significance of inflammatory biomarkers in patients (pts) with locally advanced or metastatic pancreatic ductal adenocarcinoma (PDAC) undergoing first-line chemotherapy with nab-paclitaxel and gemcitabine (NPG).
Methods
In the current cohort study data from 86 pts were retrospectively collected. All pts had histologically or cytologically confirmed locally advanced or metastatic PDAC and were treated with first-line NPG from July 2014 to March 2022. White cell (WBC), neutrophil (NEUT), lymphocyte (LYMPH), monocyte (MONO) and platelet (PLT) blood levels during the last two days before the start of the first cycle of chemotherapy were measured. Median neutrophil to lymphocyte ratio (NLR), median monocyte to lymphocyte ratio (MLR), median systemic inflammatory response index (SIRI=NEUT × MONO/LYMPH) and median platelet-to-lymphocyte ratio (PLR) were calculated. The prognostic significance of the above biomarkers was assessed by Cox proportional hazards models. The best prognostic cutoff value of the biomarkers for 1-year OS was assessed by ROC curves (highest Youden index).
Results
Median age was 68 years (range, 43-82), while 44 (51.2%) were male. PS ECOG was zero in 44 (51.2%) pts, one in 36 (41.8%) and two in 6 (7%) pts. Sixty-five (75.6%) patients had stage IV and 21 (24.4%) had stage III disease. After a median follow-up of 38 months (range, 1-47.8), 71 pts (82.6%) died of disease. Median overall survival (OS) was 10.6 months (95%CI, 7.5-13.7). Pts with stage III had median OS 13.7 months (95%CI 8.1-19.3), while stage IV pts had median OS 9.9 months (95%CI 6.5-13.4, p=0.401). Pts with PS ECOG 0 had median OS 13.7 months (95%CI, 7.1-20.3), with PS 1 had median OS 8.2 months (95%CI, 6.2-10.2) and those with PS 2 had median OS 5.5 months (95%CI, 4.5-6.6), p=0.001. Increasing NLR levels were correlated with poorer OS (HR 1.10, 95%CI 1.01-1.20, p=0.030). Other inflammatory parameters did not show prognostic significance. Cox proportional hazard models confirmed that higher NLR levels were independently associated with poorer OS (HR 1.12, 95%CI 1.02-1.22, p=0.017). Also, PS ECOG 1-2 (compared to PS 0) showed independent prognostic significance for OS (HR 2.27, 95%CI 1.37-3.75, p=0.001). In contrast, tumor stage did not demonstrate independent prognostic significance. The best prognostic cutoff value of NLR for 1-year OS (the value with the highest Youden index) was 4.5. Median OS of pts with NLR ≥4.5 was significantly shorter compared to NLR < 4.5 (6.3 vs. 11.5 months, respectively, p=0.044). Subgroup analysis showed that NLR was particularly prognostic for pts with PS ECOG 0. Pts with NLR < 4.5 and PS ECOG 0 compared to those with NLR ≥4.5 and/or PS ECOG 0 had significantly shorter median OS (7 vs. 17 months, respectively, p=0.023).
Conclusions
The present retrospective analysis revealed clinically meaningful subgroups with distinct prognoses according to inflammatory biomarkers and performance status, irrespective of tumor stage, in patients with advanced pancreatic adenocarcinoma treated with first-line nab-paclitaxel – gemcitabine.
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
