Department of HPB Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
J Surg Oncol. 2018 Sep;118(4):680-686. doi: 10.1002/jso.25209. Epub 2018 Sep 9.
Several serum based-markers and ratios have been investigated for their prognostic value in pancreatic ductal adenocarcinoma (PDAC). This cohort study aimed to combine these into a novel prognostic scoring system.
A retrospective cohort study was performed on 145 patients with unresectable histologically-confirmed PDAC. Based on the existing literature the following markers were investigated: neutrophil-lymphocyte ratio (NLR), neutrophil-albumin ratio (NAR), platelet-lymphocyte ratio (PLR), fibrinogen, and Ca19-9. These values were dichotomized about their medians for Kaplan-Meier and Cox regression analysis.
Univariate Cox regression revealed statistically significant prognostic value for: NLR, NAR, PLR, fibrinogen, and Ca19-9. When combining these using Cox regression analysis adjusting for other prognostic indicators, only NAR (hazard ratios [HR] = 3.174, P = 0.022) and Ca19-9 (HR = 2.697, P = 0.031) were independent predictors of survival. Combining NAR and Ca19-9 we split the cohort into three "NARCA" groups: NARCA0 = NAR ≤ 0.13 and Ca19-9 ≤ 770, NARCA1 = either NAR > 0.13 or Ca19-9 >770, NARCA2 = NAR > 0.13 and Ca19-9 > 770. Median survival was 20.5, 9.7 and 4.1 months in NARCA0, 1, and 2 respectively ( P < 0.0005, log-rank test). A separate validation cohort confirmed the prognostic significance of the score ( P = 0.048).
Combining NAR and Ca19-9 into a prognostic score allows stratification of unresectable PDAC patients into groups with significantly different overall survival.
已有多项基于血清的标志物和比值被用于研究其在胰腺导管腺癌（PDAC）中的预后价值。本队列研究旨在将这些标志物和比值组合成一种新的预后评分系统。
对 145 例经组织学证实不可切除的 PDAC 患者进行回顾性队列研究。基于现有文献，研究了以下标志物：中性粒细胞与淋巴细胞比值（NLR）、中性粒细胞与白蛋白比值（NAR）、血小板与淋巴细胞比值（PLR）、纤维蛋白原和 CA19-9。这些值按中位数分为二项式，用于 Kaplan-Meier 和 Cox 回归分析。
单因素 Cox 回归分析显示 NLR、NAR、PLR、纤维蛋白原和 CA19-9 具有统计学显著的预后价值。当使用 Cox 回归分析结合其他预后指标进行组合时，只有 NAR（风险比 [HR] = 3.174，P = 0.022）和 CA19-9（HR = 2.697，P = 0.031）是生存的独立预测因素。将 NAR 和 CA19-9 结合起来，我们将队列分为三组“NARCA”：NARCA0 = NAR≤0.13 且 CA19-9≤770，NARCA1 = NAR>0.13 或 CA19-9>770，NARCA2 = NAR>0.13 且 CA19-9>770。NARCA0、1 和 2 组的中位生存时间分别为 20.5、9.7 和 4.1 个月（P<0.0005，对数秩检验）。一个独立的验证队列证实了该评分的预后意义（P=0.048）。
将 NAR 和 CA19-9 组合成一个预后评分系统，可以将不可切除的 PDAC 患者分为具有显著不同总生存期的亚组。
