Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan.
Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan.
BMC Cancer. 2024 Nov 29;24(1):1469. doi: 10.1186/s12885-024-13244-z.
Reports on the association of perioperative nutritional and inflammatory status with the clinical course of adjuvant chemotherapy did not include neoadjuvant chemotherapy. We aimed to clarify the mechanism by which perioperative nutritional and inflammatory status affect the clinical course of postoperative adjuvant chemotherapy in patients with pancreatic cancer.
We enrolled 123 patients with pancreatic cancer retrospectively who underwent surgical resection with neoadjuvant and S-1 adjuvant chemotherapy between January 2013 and December 2022. The duration of continuing S-1 treatment and the continuation rates at 3 and 6 months after initiating adjuvant chemotherapy were calculated using the Kaplan-Meier method. The log-rank test was used to evaluate statistical differences between the high and low prognostic nutritional index (PNI) groups. Univariable and multivariable analyses were performed to determine the risk factors for continuing S-1 adjuvant chemotherapy.
The optimal cut-off value for preoperative PNI was 45. Preoperative PNI was an independent risk factor for continuing S-1 adjuvant chemotherapy in patients who underwent perioperative adjuvant chemotherapy and surgical resection (hazard ratio = 2.435, 95% confidence interval = 1.229 - 4.824, p = 0.011). Low PNI was associated with lower S-1completion (p = 0.02) and higher S-1 withdrawal (p = 0.031). Additionally, the preoperative PNI status affected ≥ grade 2 adverse events caused by adjuvant chemotherapy (p < 0.001).
Preoperative PNI affected adjuvant chemotherapy continuation and related adverse events in patients who underwent neoadjuvant chemotherapy and curative resection. Additional perioperative anti-inflammatory management and nutritional support may be required to improve the clinical course of postoperative adjuvant chemotherapy and patient survival.
关于围手术期营养和炎症状态与辅助化疗临床过程之间关联的报告未包括新辅助化疗。我们旨在阐明围手术期营养和炎症状态如何影响接受新辅助化疗和 S-1 辅助化疗的胰腺癌患者术后辅助化疗的临床过程。
我们回顾性地招募了 123 名接受新辅助和 S-1 辅助化疗的胰腺癌患者，这些患者于 2013 年 1 月至 2022 年 12 月期间接受了手术切除。使用 Kaplan-Meier 法计算继续 S-1 治疗的持续时间和辅助化疗开始后 3 个月和 6 个月的继续率。使用对数秩检验评估高和低预后营养指数（PNI）组之间的统计学差异。进行单变量和多变量分析以确定继续 S-1 辅助化疗的风险因素。
术前 PNI 的最佳截断值为 45。术前 PNI 是接受围手术期辅助化疗和手术切除的患者继续 S-1 辅助化疗的独立危险因素（危险比=2.435，95%置信区间=1.229-4.824，p=0.011）。低 PNI 与 S-1 完成率较低（p=0.02）和 S-1 停药率较高（p=0.031）相关。此外，术前 PNI 状态影响辅助化疗引起的≥2 级不良事件（p<0.001）。
术前 PNI 影响接受新辅助化疗和根治性切除的患者辅助化疗的持续时间和相关不良事件。可能需要额外的围手术期抗炎管理和营养支持，以改善术后辅助化疗和患者生存的临床过程。
