Pacheco-Barcia Vilma, Custodio-Cabello Sara, Carrasco-Valero Fatima, Palka-Kotlowska Magda, Mariño-Mendez Axel, Carmona-Bayonas Alberto, Gallego Javier, Martín A J Muñoz, Jimenez-Fonseca Paula, Cabezon-Gutierrez Luis
Department of Medical Oncology, Hospital Universitario de Torrejon, Madrid 28850, Spain.
Department of Internal Medicine, Hospital Universitario de Torrejon, Madrid 28850, Spain.
World J Gastrointest Oncol. 2024 Feb 15;16(2):386-397. doi: 10.4251/wjgo.v16.i2.386.
The prognostic value of the Systemic Inflammation Response Index (SIRI) in advanced pancreatic cancer is recognized, but its correlation with patients´ nutritional status and outcomes remains unexplored.
To study the prognostic significance of SIRI and weight loss in metastatic pancreatic cancer.
The PANTHEIA-Spanish Society of Medical Oncology (SEOM) study is a multicentric (16 Spanish hospitals), observational, longitudinal, non-interventional initiative, promoted by the SEOM Real World-Evidence work group. This pilot study sought to analyze the association between weight loss and inflammatory status as defined by SIRI. The cohort stems from a proof-of-concept pilot study conducted at one of the coordinating centers. Patients with pathologically confirmed metastatic pancreatic adenocarcinoma, treated from January 2020 to January 2023, were included. The index was calculated using the product of neutrophil and monocyte counts, divided by lymphocyte counts, obtained within 15 days before initiation chemotherapy. This study evaluated associations between overall survival (OS), SIRI and weight loss.
A total of 50 patients were included. 66% of these patients were male and the median age was 66 years. Metastasis sites: 36% liver, 12% peritoneal carcinomatosis, 10% lung, and 42% multiple locations. Regarding the first line palliative chemotherapy treatments: 50% received gemcitabine plus nab-paclitaxel; 28%, modified fluorouracil, leucovorin, irinotecan and oxaliplatin, and 16% were administered gemcitabine. 42% had a weight loss > 5% in the three months (mo) preceding diagnosis. 21 patients with a SIRI ≥ 2.3 × 10/L exhibited a trend towards a lower median OS compared to those with a SIRI < 2.3 × 10/L (4 18 mo; < 0.000). Among 21 patients with > 5% weight loss before diagnosis, the median OS was 6 mo, in contrast to 19 mo for those who did not experience such weight loss ( = 0.003). Patients with a weight loss > 5% showed higher SIRI levels. This difference was statistically significant ( < 0.000). For patients with a SIRI < 2.3 × 10/L, those who did not lose > 5% of their weight had an OS of 20 mo, compared to 11 mo for those who did ( < 0.001). No association was found between carbohydrate antigen 19-9 levels ≥ 1000 U/mL and weight loss.
A higher SIRI was correlated with decreased survival rates in patients with metastatic pancreatic cancer and associated with weight loss. An elevated SIRI is suggested as a predictor of survival, emphasizing the need for prospective validation in the upcoming PANTHEIA-SEOM study.
全身炎症反应指数（SIRI）在晚期胰腺癌中的预后价值已得到认可，但其与患者营养状况及预后的相关性仍未得到探索。
研究SIRI和体重减轻在转移性胰腺癌中的预后意义。
PANTHEIA - 西班牙医学肿瘤学会（SEOM）研究是一项多中心（16家西班牙医院）、观察性、纵向、非干预性研究，由SEOM真实世界证据工作组推动。这项初步研究旨在分析体重减轻与SIRI所定义的炎症状态之间的关联。该队列源于在其中一个协调中心进行的概念验证性初步研究。纳入了2020年1月至2023年1月期间接受治疗的经病理证实的转移性胰腺腺癌患者。该指数通过中性粒细胞和单核细胞计数的乘积除以淋巴细胞计数来计算，这些数据在开始化疗前15天内获取。本研究评估了总生存期（OS）、SIRI和体重减轻之间的关联。
共纳入50例患者。这些患者中66%为男性，中位年龄为66岁。转移部位：36%为肝脏，12%为腹膜癌，10%为肺，42%为多个部位。关于一线姑息化疗治疗：50%接受吉西他滨加纳米白蛋白结合型紫杉醇；28%接受改良氟尿嘧啶、亚叶酸钙、伊立替康和奥沙利铂，16%接受吉西他滨。42%的患者在诊断前三个月体重减轻>5%。SIRI≥2.3×10/L的21例患者与SIRI<2.3×10/L的患者相比，中位OS有降低趋势（4对18个月；P<0.000）。在诊断前体重减轻>5%的21例患者中，中位OS为6个月，而未经历此类体重减轻的患者为19个月（P = 0.003）。体重减轻>5%的患者SIRI水平更高。这种差异具有统计学意义（P<0.000）。对于SIRI<2.3×10/L的患者，体重未减轻>5%的患者OS为20个月，而体重减轻>5%的患者为11个月（P<0.001）。未发现碳水化合物抗原19 - 9水平≥1000 U/mL与体重减轻之间存在关联。
较高的SIRI与转移性胰腺癌患者生存率降低相关，并与体重减轻有关。建议将升高的SIRI作为生存预测指标，强调在即将开展的PANTHEIA - SEOM研究中进行前瞻性验证的必要性。
