Sanjay Pandanaboyana, de Figueiredo Rodrigo S, Leaver Heather, Ogston Simon, Kulli Christoph, Polignano Francesco M, Tait Iain S
Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.
JOP. 2012 Mar 10;13(2):199-204.
There is paucity of data on the prognostic value of pre-operative inflammatory response and post-operative lymph node ratio on patient survival after pancreatic-head resection for pancreatic ductal adenocarcinoma.
To evaluate the role of the preoperative inflammatory response and postoperative pathology criteria to identify predictive and/or prognostic variables for pancreatic ductal adenocarcinoma.
All patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma between 2002 and 2008 were reviewed retrospectively. The following impacts on patient survival were assessed: i) preoperative serum CRP levels, white cell count, neutrophil count, neutrophil/lymphocyte ratio, lymphocyte count, platelet/lymphocyte ratio; and ii) post-operative pathology criteria including lymph node status and lymph node ratio.
Fifty-one patients underwent potentially curative resection for pancreatic ductal adenocarcinoma during the study period. An elevated preoperative CRP level (greater than 3 mg/L) was found to be a significant adverse prognostic factor (P=0.015) predicting a poor survival, whereas white cell count (P=0.278), neutrophil count (P=0.850), neutrophil/lymphocyte ratio (P=0.272), platelet/lymphocyte ratio (P=0.532) and lymphocyte count (P=0.721) were not significant prognosticators at univariate analysis. Presence of metastatic lymph nodes did not adversely affect survival (P=0.050), however a raised lymph node ratio predicted poor survival at univariate analysis (P<0.001). The preoperative serum CRP level retained significance at multivariate analysis (P=0.011), together with lymph node ratio (P<0.001) and tumour size (greater than 2 cm; P=0.008).
A pre-operative elevated serum CRP level and raised post-operative lymph node ratio represent significant independent prognostic factors that predict poor prognosis in patients undergoing curative resection for pancreatic ductal adenocarcinoma. There is potential for future neo-adjuvant and adjuvant treatment strategies in pancreatic cancer to be tailored based on preoperative and postoperative factors that predict a poor survival.
关于术前炎症反应和术后淋巴结比率对胰腺导管腺癌胰头切除术后患者生存的预后价值的数据较少。
评估术前炎症反应和术后病理标准在识别胰腺导管腺癌预测和/或预后变量中的作用。
回顾性分析2002年至2008年间所有因胰腺导管腺癌接受胰十二指肠切除术的患者。评估以下对患者生存的影响：i）术前血清CRP水平、白细胞计数、中性粒细胞计数、中性粒细胞/淋巴细胞比率、淋巴细胞计数、血小板/淋巴细胞比率；ii）术后病理标准，包括淋巴结状态和淋巴结比率。
在研究期间，51例患者接受了胰腺导管腺癌的潜在根治性切除。术前CRP水平升高（大于3mg/L）被发现是预测生存不良的显著不良预后因素（P=0.015），而在单因素分析中，白细胞计数（P=0.278）、中性粒细胞计数（P=0.850）、中性粒细胞/淋巴细胞比率（P=0.272）、血小板/淋巴细胞比率（P=0.532）和淋巴细胞计数（P=0.721）不是显著的预后指标。转移性淋巴结的存在对生存没有不利影响（P=0.050），然而在单因素分析中，升高的淋巴结比率预测生存不良（P<0.001）。术前血清CRP水平在多因素分析中仍具有显著性（P=0.011），与淋巴结比率（P<0.001）和肿瘤大小（大于2cm；P=0.008）一起。
术前血清CRP水平升高和术后淋巴结比率升高是预测胰腺导管腺癌根治性切除患者预后不良的显著独立预后因素。未来有可能根据预测生存不良的术前和术后因素，为胰腺癌量身定制新辅助和辅助治疗策略。
