Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Invest New Drugs. 2019 Jun;37(3):584-590. doi: 10.1007/s10637-018-0681-y. Epub 2018 Oct 16.
Background Nab-paclitaxel plus gemcitabine (AG) is standard first-line chemotherapy for patients with metastatic pancreatic cancer (mPC). However, prognostic factors for patients with mPC treated with AG, are largely unknown. We retrospectively identified prognostic factors, including inflammation-based prognostic scores, in patients with mPC, and recurrent pancreatic cancer treated with AG as first-line treatment. Method A total of 203 patients with histologically-confirmed recurrent or metastatic pancreatic cancer who were treated with first-line AG in Asan Medical Center, Seoul, Korea, between February 2016 and December 2016 were included in this analysis. As inflammation-based scores, baseline neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and modified Glasgow prognostic scores (mGPS) were tested. Result Median age was 62 years and 116 patients (57%) were male. With median follow-up duration of 21.5 months, median progression-free survival (PFS) was 7.1 (95% CI 6.2-7.9) months, and overall survival (OS) was 15.1 (95% CI 12.6-17.6) months. In the multivariate analysis, PFS was significantly associated with liver metastasis (HR 1.43), distant lymph node metastasis (HR 1.48), and elevated CA19-9 (HR 1.56). In multivariate analysis for OS, elevated CA19-9 (HR 1.75), liver metastasis (HR 1.76), distant lymph node metastasis (HR 1.41), and high mGPS (mGPS ≥1 vs.0: HR 1.64) were independent prognostic factors. NLR and PLR were not significantly associated with PFS and OS. Conclusion Among the inflammation based prognostic scores, mGPS was a reliable prognostic indicator that could stratify survival outcomes in patients with recurrent or mPC who received AG as first-line chemotherapy.
纳武利尤单抗联合吉西他滨（AG）是转移性胰腺癌（mPC）患者的标准一线化疗方案。然而，接受 AG 治疗的 mPC 患者的预后因素在很大程度上尚不清楚。我们回顾性地确定了包括炎症相关预后评分在内的预后因素，这些因素存在于接受 AG 作为一线治疗的 mPC 和复发性胰腺癌患者中。
本研究共纳入 203 例在韩国首尔 Asan 医疗中心接受一线 AG 治疗的组织学证实复发性或转移性胰腺癌患者。这些患者于 2016 年 2 月至 2016 年 12 月接受治疗。作为炎症相关评分，基线中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和改良格拉斯哥预后评分（mGPS）被进行了检测。
中位年龄为 62 岁，116 例（57%）为男性。中位随访时间为 21.5 个月，中位无进展生存期（PFS）为 7.1（95%CI 6.2-7.9）个月，总生存期（OS）为 15.1（95%CI 12.6-17.6）个月。多变量分析显示，PFS 与肝转移（HR 1.43）、远处淋巴结转移（HR 1.48）和 CA19-9 升高（HR 1.56）显著相关。在 OS 的多变量分析中，CA19-9 升高（HR 1.75）、肝转移（HR 1.76）、远处淋巴结转移（HR 1.41）和高 mGPS（mGPS≥1 比 0：HR 1.64）是独立的预后因素。NLR 和 PLR 与 PFS 和 OS 无显著相关性。
在炎症相关预后评分中，mGPS 是一个可靠的预后指标，可对接受 AG 作为一线化疗的复发性或 mPC 患者的生存结果进行分层。
