Establishing recurrence indicators and stratifying pancreatic ductal adenocarcinoma based on routine laboratory exams. Is it time to incorporate these parameters in daily clinical practice?

PURPOSE

Systemic inflammation plays a crucial role in carcinogenesis and progression of pancreatic cancer, due to its influence on tumor angiogenesis, invasion and metastasis. The association of CA 19-9, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) can identify patients with different prognoses.

METHODS

We reviewed 148 pancreatic cancer patients' charts diagnosed from January 2006 to December 2018 in a tertiary hospital. Cox proportional survival models were used to evaluate the impact of each factor on recurrence-free and overall survival (OS).

RESULTS

When assessing risk of relapse, the presence of angiolymphatic invasion was associated with an 80% chance of recurrence in 5 years. Among other factors associated with OS, the estimated risk of death in patients with CA 19-9>300 U/mL was 2.37-fold higher compared to lower values. In addition, the risk of death was 60% and 76% higher in patients with NLR>3 and PLR>150, respectively. Patients within these 3 categories had a median OS of only 7.5 months, lower than all-comer patients with stage IV disease, with median OS estimated at 9.84 months.

CONCLUSION

The laboratory variables CA 19-9, NLR and PLR together can contribute to a better stratification of patients with pancreatic adenocarcinoma beyond conventional staging. Prospective initiatives using these factors together can demonstrate different subgroups of patients who benefit from new treatment strategies.