Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA.
Department of Internal Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA.
J Gastrointest Cancer. 2021 Mar;52(1):160-168. doi: 10.1007/s12029-020-00378-z.
Pancreatic adenocarcinoma remains a malignancy with poor prognosis. Black patients experience poorer overall survival compared with other races. Recent studies have elucidated certain prognostic factors at the time of diagnosis of pancreatic cancer which have largely not been studied for differences between racial groups. We present a study examining differences in blood levels between Black and non-Black patients and their effects on overall survival.
This is a retrospective cohort study. One hundred sixty-three patients were confirmed to carry a tissue diagnosis of pancreatic adenocarcinoma and included in analysis; 27 of the patients were self-identified as "Black"; 136 were analyzed together as "Non-Black" with the majority identifying as "White". Various blood markers were drawn at the time of diagnosis. Kaplan-Meier and multivariable Cox regression models were used to examine differences in these factors between Black and non-Black patients, as well as their effect on overall survival.
Black patients were younger at diagnosis (p = 0.001) and were more likely to experience significant weight loss leading up to diagnosis (p = 0.009); Black patients also had a lower neutrophil-to-lymphocyte ratio (NLR) (p = 0.001) and higher lymphocyte-to-monocyte ratio (LMR) (p = 0.001) at diagnosis. In multivariable analysis, an NLR > 3.5 had a significantly negative impact on overall survival (p = 0.002), as did the presence of metastatic disease (p < 0.001).
Black patients demonstrated a "favorable" white blood cell profile (higher LMR, lower NLR) compared with non-Black patients. This may suggest that the immune response in pancreatic adenocarcinoma is not what is driving disparately poor outcomes in Black patients. Further study is warranted to ascertain the role of immune response in pancreatic adenocarcinoma, the prognostic use of these measurements at diagnosis, and possible other factors, such as genetics, which may better explain poorer outcomes in Black patients.
胰腺腺癌仍然是一种预后不良的恶性肿瘤。与其他种族相比，黑人患者的总生存率较差。最近的研究已经阐明了胰腺癌诊断时的某些预后因素，但这些因素在不同种族群体之间的差异尚未得到广泛研究。我们进行了一项研究，检查黑人和非黑人患者之间血液水平的差异及其对总生存率的影响。
这是一项回顾性队列研究。163 名患者被证实携带胰腺腺癌的组织诊断，并纳入分析；其中 27 名患者自我认定为“黑人”；136 名患者被分析为“非黑人”，其中大多数人认定为“白人”。在诊断时抽取了各种血液标志物。使用 Kaplan-Meier 和多变量 Cox 回归模型来检查黑人患者和非黑人患者之间这些因素的差异，以及它们对总生存率的影响。
黑人患者在诊断时更年轻（p=0.001），并且更有可能在诊断前经历显著的体重减轻（p=0.009）；黑人患者的中性粒细胞与淋巴细胞比值（NLR）也较低（p=0.001），淋巴细胞与单核细胞比值（LMR）较高（p=0.001）。在多变量分析中，NLR>3.5 对总生存率有显著的负面影响（p=0.002），转移性疾病的存在也是如此（p<0.001）。
与非黑人患者相比，黑人患者表现出“有利”的白细胞谱（更高的 LMR，更低的 NLR）。这可能表明胰腺腺癌中的免疫反应不是导致黑人患者预后不良的原因。需要进一步研究以确定免疫反应在胰腺腺癌中的作用、这些测量在诊断时的预后用途，以及可能的其他因素，如遗传因素，这些因素可能更好地解释黑人患者预后较差的原因。
