Ichikawa Ken, Mizuno Shugo, Hayasaki Aoi, Kishiwada Masashi, Fujii Takehiro, Iizawa Yusuke, Kato Hiroyuki, Tanemura Akihiro, Murata Yasuhiro, Azumi Yoshinori, Kuriyama Naohisa, Usui Masanobu, Sakurai Hiroyuki, Isaji Shuji
Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
Cancers (Basel). 2019 Apr 10;11(4):514. doi: 10.3390/cancers11040514.
: In many malignancies, including pancreatic ductal adenocarcinoma (PDAC), host-related inflammatory/immunonutritional markers, such as the prognostic nutritional index (PNI), modified Glasgow prognostic score (mGPS), and C-reactive protein (CRP)/albumin ratio are reported to be prognostic factors. However, the prognostic influence of these factors before and after chemoradiotherapy (CRT) has not been studied in PDAC patients. Of 261 consecutive PDAC patients who were scheduled for CRT with gemcitabine or S1 plus gemcitabine between February 2005 and December 2015, participants in this study were 176 who completed CRT and had full data available on inflammatory/immunonutritional markers as well as on anatomical and biological factors for the investigation of prognostic/predictive factors. : In multivariate analysis, the significant prognostic factors were RECIST classification, cT category, performance status, post-CRT carcinoembryonic antigen, post-CRT C-reactive protein/albumin ratio, post-CRT mGPS, and post-CRT PNI. Post-CRT PNI (cut-off value, 39) was the strongest host-related prognostic factor according to the -value. In the patients who underwent resection after CRT, median survival time (MST) was significantly shorter in the 12 patients with low PNI (<39) than in the 97 with high PNI (≥39), at 15.5 months versus 27.2 months, respectively ( = 0.0016). In the patients who did not undergo resection, MST was only 8.9 months in those with low PNI and 12.3 months in those with high PNI ( 0.0001), and thus was similar to that of the resected patients with low PNI. : Post-CRT PNI was the strongest prognostic/predictive indicator among the independent biological and conditional prognostic factors in PDAC patients who underwent CRT.
在许多恶性肿瘤中，包括胰腺导管腺癌（PDAC），据报道宿主相关的炎症/免疫营养标志物，如预后营养指数（PNI）、改良格拉斯哥预后评分（mGPS）以及C反应蛋白（CRP）/白蛋白比值是预后因素。然而，这些因素在放化疗（CRT）前后对PDAC患者的预后影响尚未得到研究。在2005年2月至2015年12月期间计划接受吉西他滨或S1加吉西他滨CRT的261例连续PDAC患者中，本研究的参与者为176例，他们完成了CRT，并且有关于炎症/免疫营养标志物以及用于研究预后/预测因素的解剖学和生物学因素的完整数据。在多变量分析中，显著的预后因素为RECIST分类、cT类别、体能状态、CRT后癌胚抗原、CRT后C反应蛋白/白蛋白比值、CRT后mGPS以及CRT后PNI。根据P值，CRT后PNI（临界值，39）是最强的宿主相关预后因素。在CRT后接受手术切除的患者中，PNI低（<39）的12例患者的中位生存时间（MST）显著短于PNI高（≥39）的97例患者，分别为15.5个月和27.2个月（P = 0.0016）。在未接受手术切除的患者中，PNI低的患者MST仅为8.9个月，PNI高的患者为12.3个月（P = 0.0001），因此与接受手术切除的PNI低的患者相似。CRT后PNI是接受CRT的PDAC患者独立生物学和条件性预后因素中最强的预后/预测指标。
