Preoperative Platelet–to–Albumin Ratio Predicts Prognosis of Patients with Pancreatic Ductal Adenocarcinoma After Pancreatic Resection

Shirai, Yoshio; Shiba, Hiroaki; Haruki, Koichiro; Horiuchi, Takashi; Saito, Nobuhiro; Fujiwara, Yuki; Sakamoto, Taro; Uwagawa, Tadashi; Yanaga, Katsuhiko

doi:10.21873/anticanres.11378

Cited by 60 publications

(56 citation statements)

References 26 publications

(34 reference statements)

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“…Many studies affirmed that ALB alone or based markers were correlated with survival in various cancers 23 , 25 - 27 . Similarly, ALB alone or based markers were confirmed as independent predictors of PDAC with poor survival 14 , 28 , 29 . ALP associated with ALB as a predictor had been applied into several other cancers 19 , 30 , however, the value of prediction in PDAC was still not identified.…”

Section: Introductionmentioning

confidence: 79%

“…This indicated inflammation was obviously related to the tumorgenesis of PDAC 10 , 11 . Furthermore, many studies had identified inflammation-based scores as prognostic indicators of PDAC, such as neutrophil-lymphocyte ratio (NLR), C-reactive protein/albumin (CRP/Alb) ratio, platelet-to-albumin ratio (PAR) and lymphocyte-to-monocyte ratio (LMR) 4 , 12 - 14 . Therefore, it is quite reasonable to further excavate inflammation-based score for prognostic prediction of PDAC patients.…”

Section: Introductionmentioning

confidence: 99%

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Alkaline Phosphatase-To-Albumin Ratio as a Prognostic Indicator in Pancreatic Ductal Adenocarcinoma after Curative Resection

Gao

et al. 2017

J. Cancer

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Background: The prognosis of pancreatic ductal adenocarcinoma (PDAC) remains poor and the models for survival prediction in PDAC patients after curative resection are still limited. Preoperative alkaline phosphatase-to-albumin ratio (APAR), an original inflammation-based score, has been established to analyze the prognostic significance in PDAC. Therefore, in this study, we aim to formulate a valuable prognostic nomogram for PDAC following curative resection.Methods: A total of 354 patients with PDAC undergoing curative resection were retrospectively enrolled in this study. The prognostic value of APAR was analyzed in primary cohort containing 220 randomly selected PDAC patients with curative resection and prognostic nomogram incorporating APAR into the American Joint Commission on Cancer (AJCC) 8th edition was established to obtain superior discriminatory abilities. The predictive performance of APAR was further validated in another independent cohort of 134 PDAC patients.Results: Patients with higher serum APAR level were probable to sustain poorer overall survival (OS). Significant positive correlations were found between APAR and tumor site, and several serum biochemical indexes, such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), etc. The results of multivariate analysis showed, APAR was also identified as an independent prognostic indicator for OS in both primary and validation cohorts (P=0.004, P=0.038, respectively). Compared with the AJCC 8th edition, the nomogram consisting of APAR, pathological differentiation and the TNM staging system of AJCC 8th edition showed superior predictive accuracy for OS. All these results were further verified in the validation cohort.Conclusions: APAR can be considered as a novel independent prognostic biomarker for PDAC following curative resection. One more accurate and advanced predictive model will be achieved via the incorporation of APAR into nomogram.

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Section: Introductionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Alkaline Phosphatase-To-Albumin Ratio as a Prognostic Indicator in Pancreatic Ductal Adenocarcinoma after Curative Resection

Gao

et al. 2017

J. Cancer

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“…Several studies on this topic were identified by the search, but most were excluded because of the number of tumours not resected or the absence of model performance measures. The included studies of Shirai and colleagues (platelet and albumin) and Numata et al . (Glasgow Prognostic Score and CA19.9) showed reasonable performance.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of clinical prediction models for survival after surgery for resectable pancreatic cancer

Strijker

Chen

Mungroop

et al. 2019

British Journal of Surgery

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Background: As more therapeutic options for pancreatic cancer are becoming available, there is a need to improve outcome prediction to support shared decision-making. A systematic evaluation of prediction models in resectable pancreatic cancer is lacking.Methods: This systematic review followed the CHARMS and PRISMA guidelines. PubMed, Embase and Cochrane Library databases were searched up to 11 October 2017. Studies reporting development or validation of models predicting survival in resectable pancreatic cancer were included. Models without performance measures, reviews, abstracts or more than 10 per cent of patients not undergoing resection in postoperative models were excluded. Studies were appraised critically.Results: After screening 4403 studies, 22 (44 319 patients) were included. There were 19 model development/update studies and three validation studies, altogether concerning 21 individual models. Two studies were deemed at low risk of bias. Eight models were developed for the preoperative setting and 13 for the postoperative setting. Most frequently included parameters were differentiation grade (11 of 21 models), nodal status (8 of 21) and serum albumin (7 of 21). Treatment-related variables were included in three models. The C-statistic/area under the curve values ranged from 0⋅57 to 0⋅90. Based on study design, validation methods and the availability of web-based calculators, two models were identified as the most promising. Conclusion: Although a large number of prediction models for resectable pancreatic cancer have been reported, most are at high risk of bias and have not been validated externally. This overview of prognostic factors provided practical recommendations that could help in designing easily applicable prediction models to support shared decision-making.Prediction models enable clinicians and patients to calculate the risks of a specific endpoint individualized to a patient, using combinations of predictors. Such models are used widely in some fields, including the CHADS 2 -VASc score for estimation of stroke risk in atrial fibrillation 3 , and the Acute Physiology and Chronic Health Evaluation (APACHE) score 4 for mortality in intensive care. In breast cancer, the PREDICT 5 and Adjuvant! 6 models have been employed in the decision-making process to determine adjuvant treatment administration. Data analysisData extraction was performed independently by two authors. Articles were categorized into development/model update studies and validation studies 12 .

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“…Although a series of inflammation-based scores appeared to be prognostic factors in diverse malignances 3,32 , inflammation factors were failed to be incorporated into AJCC 8th staging system or other existed predictive model in PDAC. Intriguingly, AJCC 8th staging system integrating poNLR in Table 3 indicated that the incorporated nomograms led to higher C-indices than that of AJCC 8th staging system alone.…”

Section: Discussionmentioning

confidence: 99%

Independent effect of postoperative neutrophil-to-lymphocyte ratio on the survival of pancreatic ductal adenocarcinoma with open distal pancreatosplenectomy and its nomogram-based prediction

Yin

Zhao

et al. 2019

J. Cancer

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Background: The prognosis of pancreatic ductal adenocarcinoma (PDAC) remains poor. Open distal pancreatosplenectomy (ODPS) is prevalent in the patients of early PDAC located in pancreatic body or tail. However, the models for relapse or survival prediction in those patients are still limited. Postoperative neutrophil-to-lymphocyte rate (poNLR), a novel inflammation-based score, has been formulated to analyze the prognostic significance in PDAC patients with ODPS. Therefore, this study aims to generate a valuable prognostic nomogram for PDAC following ODPS. Methods: We retrospectively enrolled 97 patients of PDAC undergoing ODPS in this study. The Cox proportional hazards regression methodology was used in univariate and multivariate survival analyses to identify significant independent prognostic factors. The prognostic nomograms integrating poNLR into the American Joint Commission on Cancer (AJCC) staging system (8th edition) for predicting overall survival (OS) and relapse free survival (RFS) were established to achieve superior discriminatory abilities. Further, these prognostic nomograms were verified according to concordance index (C-index), calibrations and decision curve analyses (DCA). Results: The optimal cutoff value of poNLR for assessing OS determined by X-tile program was 14.1. Higher poNLR was associated with higher postoperative neutrophil (poNeutrophil), lower postoperative lymphocyte (poLymphocyte), lower preoperative lymphocyte-to-monocyte rate (preLMR) and higher △NLR (postoperative-preoperative NLR). In the univariate and multivariate analysis, poNLR was identified as an independent prognostic indicator for OS and RFS (P=0.044 and 0.028, respectively) and patients with higher poNLR level were probable to have shorter OS and RFS. Compared with the TNM staging system of the AJCC 8th edition, the nomogram comprising of poNLR and AJCC 8th edition exhibited superior predictive accuracy for OS and RFS. Conclusions: poNLR can be a proven, inexpensive and novel survival predictor of PDAC patients with ODPS. One more advanced and accurate predictive model will be achieved to assist in risk stratification via the incorporation of poNLR into nomograms.

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Preoperative Platelet–to–Albumin Ratio Predicts Prognosis of Patients with Pancreatic Ductal Adenocarcinoma After Pancreatic Resection

Abstract: The preoperative PAR is a novel significant independent prognostic index for DFS and OS in patients after pancreatic resection with curative intent.

Cited by 60 publications

References 26 publications

Alkaline Phosphatase-To-Albumin Ratio as a Prognostic Indicator in Pancreatic Ductal Adenocarcinoma after Curative Resection

Alkaline Phosphatase-To-Albumin Ratio as a Prognostic Indicator in Pancreatic Ductal Adenocarcinoma after Curative Resection

Systematic review of clinical prediction models for survival after surgery for resectable pancreatic cancer

Independent effect of postoperative neutrophil-to-lymphocyte ratio on the survival of pancreatic ductal adenocarcinoma with open distal pancreatosplenectomy and its nomogram-based prediction

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