Zhong Ailing, Cheng Chien-Shan, Kai Jinyan, Lu Renquan, Guo Lin
Department of Clinical Laboratory, Shanghai Cancer Center, Fudan University, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Front Oncol. 2020 Sep 30;10:520330. doi: 10.3389/fonc.2020.520330. eCollection 2020.
Glucose metabolism and systemic inflammation have been associated with cancer aggressiveness and patient prognosis in various malignancies. This study aimed to evaluate the prognostic significance of pretreatment GLR(glucose to lymphocyte ratio) and systemic immune inflammation in patients with pancreatic cancer. We studied 360 patients with pathologically diagnosed pancreatic adenocarcinoma that was clinically unresectable. Baseline clinicopathological characteristics and laboratory investigations including fasting blood glucose, platelet count, lymphocyte count, neutrophil count, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA199), and follow-up data were collected for further analysis. The patients were randomly divided into a training cohort ( = 238) and a validation cohort ( = 122). Univariate and multivariate Cox proportional hazard regression analyses were performed to identify the prognostic value of GLR, systemic immune-inflammation markers, and tumor biomarkers. A nomogram model was developed based on the identified prognostic factors, and we used the C-index to evaluate the accuracy of the Cox regression model prediction. Multivariate analysis revealed that GLR [hazard ratio (HR): 2.597; 95% confidence interval (CI): 1.728-3.904)] and CA199 (HR: 2.484; 95% CI: 1.295-4.765) are independent predictors of poor overall survival in the training cohort and were incorporated into the nomogram for OS as independent factors. Moreover, the C-index analyses demonstrated that the C-indexes in the training cohort and the validation cohort were 0.674 and 0.671, respectively. The nomogram model predicts overall survival relatively accurately. We found that the baseline GLR is an independent prognostic factor for patients with pancreatic cancer, and the proposed nomogram can be used as an effective tool for predicting the outcomes of prognosis of patients with pancreatic cancer.
葡萄糖代谢和全身炎症与多种恶性肿瘤的癌症侵袭性及患者预后相关。本研究旨在评估治疗前葡萄糖与淋巴细胞比值（GLR）及全身免疫炎症在胰腺癌患者中的预后意义。我们研究了360例经病理诊断为临床不可切除的胰腺腺癌患者。收集了基线临床病理特征及实验室检查结果，包括空腹血糖、血小板计数、淋巴细胞计数、中性粒细胞计数、癌胚抗原（CEA）、糖类抗原19-9（CA199），并收集随访数据用于进一步分析。患者被随机分为训练队列（n = 238）和验证队列（n = 122）。进行单因素和多因素Cox比例风险回归分析，以确定GLR、全身免疫炎症标志物和肿瘤生物标志物的预后价值。基于确定的预后因素建立了列线图模型，并使用C指数评估Cox回归模型预测的准确性。多因素分析显示，在训练队列中，GLR [风险比（HR）：2.597；95%置信区间（CI）：1.728 - 3.904]和CA199（HR：2.484；95% CI：1.295 - 4.765）是总生存期较差的独立预测因素，并作为独立因素纳入总生存期列线图。此外，C指数分析表明，训练队列和验证队列的C指数分别为0.674和0.671。列线图模型对总生存期的预测相对准确。我们发现基线GLR是胰腺癌患者的独立预后因素，所提出的列线图可作为预测胰腺癌患者预后结果的有效工具。
