Background
Nutritional status and tumor markers are important prognostic indicators for surgical
decisions in pancreatic carcinoma. This study aimed to stratify the probability of
surviving pancreatic carcinoma based on systematically chosen nonanatomic biomarkers.
Methods
We included 187 consecutive patients that underwent surgical resections for pancreatic
carcinoma. We performed multivariable analyses to evaluate prognostic indicators,
including 4 blood-test indexes: the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte
ratio, prognostic nutritional index, and the modified Glasgow prognostic score; and
4 body-composition indexes: the normalized total psoas muscle area, the normalized
total elector spine muscle area, the psoas muscle computed tomography value, and the
elector spine muscle computed tomography value.
Results
Poor survival was associated with 2 independent risk factors: neutrophil-to-lymphocyte
ratio ≥3.0 (hazard ratio, 1.54) and prognostic nutritional index <36 (hazard ratio,
1.60), and with high carbohydrate antigen 19-9 levels (≥37 IU/mL). The 2 indexes were
not significantly associated with clinicopathological factors, including carbohydrate
antigen 19-9. Patients with no risk factors had significantly better survival than
those with 1 (P = .007) or 2 risk factors (P = .001), and survival was similar in the latter 2 groups (P = .253). A presurgical nonanatomic scoring system (range, 0−2) was constructed: 0 points
for no risk factors, 1 point for 1 or 2 nutritional risk factors, and 1 point for
carbohydrate antigen 19-9 ≥37 IU/mL. Survival rate at 3 years decreased with increasing
scores (76% for score 0, 42% for score 1, and 21% for score 2; all P < .05).
Conclusion
Neutrophil-to-lymphocyte ratio and prognostic nutritional index were independent prognostic
risk factors in pancreatic carcinoma and integrating these indexes with carbohydrate
antigen 19-9 levels could successfully stratify survival.
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Article info
Publication history
Published online: January 07, 2021
Accepted:
November 23,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
