Multiple preoperative indicators may be used as prognostic markers for patients with operable pancreatic ductal adenocarcinoma, according to a new study.
The prognosis of patients with pancreatic ductal adenocarcinoma is usual poor, even for those who undergo curative resection. Prior research has demonstrated an association between preoperative chronic inflammation, low, immunity and poor nutrition with lower survival rates. However, the prognostic and clinical importance of serum markers of chronic inflammation, nutrition, and immunity combined with tumor markers of pancreatic cancer are in need of further evaluation.
Masahide Ikeguchi, MD, department of surgery, Tottori Prefectural Central Hospital (Japan), and colleagues conducted a study to analyze which preoperative indicators at the time of hospital admission (ie, C-reactive protein/albumin ratio [CAR], neutrophil/lymphocyte ratio [NLR], prognostic nutritional index [PNI], carcinoembryonic antigen [CEA], and carbohydrate antigen 19-9 [CA 19-9]) were the most relevant risk factors for postoperative pancreatic fistula and poor survival in pancreatic cancer. Researchers identified 43 patients with pancreatic ductal adenocarcinoma who underwent curative resection without receiving prior chemotherapy or radiation between 2006 and 2015.
Results of the study were published in the Journal of Pancreatic Cancer (online July 1, 2017; doi:10.1089/crpc.2017.0006).
After a mean follow-up period of 25.2 months, postoperative pancreatic fistula was detected in eight (18.6%) of the patients. However, none of the assessed preoperative markers were strongly associated with an increased risk of postoperative pancreatic fistula.
The overall survival (OS) rate after 5-years was 22.4%, and patients achieved a median survival time of 21 months. Researchers found that 5-year OS in patients with low preoperative PNI was 4%, compared with 35% in patients with a high PNI (P = .001). Additionally, a strong correlation was identified between poor 5-year OS and high preoperative CAR, though no statistically significance was recorded.
Researchers concluded that low PNI and high CAR levels before curative resection are strongly associated with poor outcomes in pancreatic ductal adenocarcinoma. These markers can be used as prognostic identifiers and should help guide treatment strategies for patients with such disease, they wrote.—Zachary Bessette