Hackner Danilo, Merkel Susanne, Weiß Andreas, Krautz Christian, Weber Georg F, Grützmann Robert, Brunner Maximilian
Department of General and Visceral Surgery, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054 Erlangen, Germany.
Department of Anaesthesiology, LMU University Hospital, LMU Munich, 81377 Munich, Germany.
Cancers (Basel). 2024 Aug 22;16(16):2911. doi: 10.3390/cancers16162911.
Prognostic inflammation-based parameters have been reported as useful tools in various oncologic diseases. Pancreatic ductal adenocarcinoma (PDAC) is characterized by a high mortality rate, making reliable prognostic markers highly desirable. However, there is still inconsistency in the literature regarding the efficacy of the different available scores.
A total of 207 patients, who underwent primary resection of PDAC from January 2000 to December 2018 at the University Hospital of Erlangen, were included in this retrospective single-center study. Different biomarkers, including the preoperative neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), the c-reactive protein (CRP)-albumin ratio (CAR), the lymphocyte-CRP ratio (LCR), the prognostic nutritional index (PNI) and the modified Glasgow prognostic score (mGPS) were analyzed for their ability to predict overall survival (OS).
In our cohort, the median overall survival was 20.7 months. Among the investigated biomarkers, NLR and PNI were identified as independent prognostic markers (Hazard Ratio (HR) 1.6 (1.0-2.5), = 0.048 and HR 0.6 (0.4-0.9), = 0.018), whereas PLR, CAR, LCR and mGPS did not reach significance in the multivariate analysis. Subgroup analysis revealed that the prognostic value of NLR and PNI is particularly evident in locally advanced tumor stages (pT3/4 and pN+).
The NLR and PNI could serve as valuable tools for estimating prognosis in patients with PDAC undergoing pancreatic resection in curative intention, especially in locally advanced tumor stages. However, conflicting results in the current literature highlight the need for further prospective studies to validate these findings.
基于炎症的预后参数已被报道为各种肿瘤疾病中的有用工具。胰腺导管腺癌（PDAC）的特点是死亡率高，因此非常需要可靠的预后标志物。然而，关于不同现有评分的疗效，文献中仍存在不一致之处。
本回顾性单中心研究纳入了2000年1月至2018年12月在埃尔朗根大学医院接受PDAC初次切除的207例患者。分析了不同的生物标志物，包括术前中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、C反应蛋白（CRP）与白蛋白比值（CAR）、淋巴细胞与CRP比值（LCR）、预后营养指数（PNI）和改良格拉斯哥预后评分（mGPS）预测总生存期（OS）的能力。
在我们的队列中，中位总生存期为20.7个月。在研究的生物标志物中，NLR和PNI被确定为独立的预后标志物（风险比（HR）1.6（1.0 - 2.5），P = 0.048和HR 0.6（0.4 - 0.9），P = 0.018），而PLR、CAR、LCR和mGPS在多变量分析中未达到显著意义。亚组分析显示，NLR和PNI的预后价值在局部晚期肿瘤阶段（pT3/4和pN+）尤为明显。
NLR和PNI可作为评估有治愈意向接受胰腺切除术的PDAC患者预后的有价值工具，特别是在局部晚期肿瘤阶段。然而，当前文献中的矛盾结果凸显了进一步进行前瞻性研究以验证这些发现的必要性。
