可切除及边界可切除胰腺癌患者新辅助放化疗期间炎症营养因子的变化及其预后影响
Changes and prognostic impact of inflammatory nutritional factors during neoadjuvant chemoradiotherapy for patients with resectable and borderline resectable pancreatic cancer.
作者信息
Oshima Minoru, Okano Keiichi, Suto Hironobu, Ando Yasuhisa, Kamada Hideki, Masaki Tsutomu, Takahashi Shigeo, Shibata Toru, Suzuki Yasuyuki
机构信息
Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
出版信息
BMC Gastroenterol. 2020 Dec 14;20(1):423. doi: 10.1186/s12876-020-01566-8.
BACKGROUND
Inflammatory nutritional factors, such as the neutrophil/lymphocyte ratio (NLR), Glasgow Prognostic Score (GPS), modified GPS (mGPS), and C-reactive protein/albumin (CRP/Alb) ratio, have prognostic values in many types of cancer. In this study, the prognostic values of inflammatory nutritional scores were evaluated in the patients with resectable or borderline resectable pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant chemoradiotherapy (NACRT).
METHODS
A total of 49 patients who underwent pancreatectomy after NACRT from September 2009 to May 2016 were enrolled. The NACRT consisted of hypofractionated external-beam radiotherapy (30 Gy in 10 fractions) with concurrent S-1 (60 mg/m) delivered 5 days/week for 2 weeks before pancreatectomy. Inflammatory nutritional scores were determined before and after NACRT in this series.
RESULTS
The median NLR increased after NACRT (from 2.067 to 3.302), with statistical difference (p < 0.001). In multivariate analysis, high pre-NACRT mGPS (2 or 1; p = 0.0478) and significant increase in CRP/Alb ratio after NACRT (≧ 0.077; p = 0.0036) were associated with shorter overall survival. All patients were divided into two groups according to the ΔCRP/Alb ratio after NACRT: the group with high ΔCRP/Alb ratio (≧ 0.077) and the group with low ΔCRP/Alb ratio (< 0.077). The group with high ΔCRP/Alb ratio after NACRT (n = 13) not only had higher post-NACRT CRP levels (p < 0.001) but also had lower post-NACRT Alb levels (p = 0.002). Patients in the group with high ΔCRP/Alb ratio lost more body weight during NACRT (p = 0.03).
CONCLUSION
In addition to pre-NACRT mGPS, ΔCRP/Alb after NACRT could provide prognostic value in the patients with PDAC treated by NACRT.
背景
炎症性营养因子，如中性粒细胞/淋巴细胞比值（NLR）、格拉斯哥预后评分（GPS）、改良GPS（mGPS）以及C反应蛋白/白蛋白（CRP/Alb）比值，在多种癌症中具有预后价值。在本研究中，我们评估了新辅助放化疗（NACRT）后可切除或临界可切除胰腺导管腺癌（PDAC）患者炎症性营养评分的预后价值。
方法
纳入2009年9月至2016年5月期间49例行NACRT后接受胰腺切除术的患者。NACRT包括在胰腺切除术前2周每周5天给予低分割外照射放疗（10次，共30 Gy）并同步给予S-1（60 mg/m²）。本研究系列中在NACRT前后测定炎症性营养评分。
结果
NACRT后NLR中位数升高（从2.067升至3.302），差异有统计学意义（p < 0.001）。多因素分析显示，NACRT前mGPS高（2或1；p = 0.0478）以及NACRT后CRP/Alb比值显著升高（≥ 0.077；p = 0.0036）与总生存期缩短相关。根据NACRT后ΔCRP/Alb比值将所有患者分为两组：ΔCRP/Alb比值高（≥ 0.077）组和ΔCRP/Alb比值低（< 0.077）组。NACRT后ΔCRP/Alb比值高的组（n = 13）不仅NACRT后CRP水平更高（p < 0.001），而且NACRT后Alb水平更低（p = 0.002）。ΔCRP/Alb比值高的组患者在NACRT期间体重减轻更多（p = 0.03）。
结论
除NACRT前mGPS外，NACRT后ΔCRP/Alb可为接受NACRT治疗的PDAC患者提供预后价值。
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