Simple prognostic markers for optimal treatment of patients with unresectable pancreatic cancer

Abstract

Most patients with pancreatic cancer are ineligible for curative resection at diagnosis, resulting in poor prognosis. This study aimed to evaluate the prognostic factors in patients with unresectable pancreatic cancer.We retrospectively collected clinical data from 196 patients with unresectable pancreatic cancer who received palliative chemotherapy (N = 153) or palliative care alone (N = 43) from January 2011 to December 2013. Patients' background data and overall survival were analyzed using the Cox proportional hazard regression model.In patients receiving palliative chemotherapy (gemcitabine-based regimen, 88.2%) and palliative care alone, the median (range) ages were 68 (43-91) and 78 (53-90) years, and metastatic diseases were present in 80% (N = 123) and 86% (N = 37), respectively. Multivariate analysis in the palliative chemotherapy patients showed that liver metastasis (hazard ratio [HR] 2.25, 95% confidence interval [CI] 1.58-3.20, P < .001), neutrophil-to-lymphocyte ratio (>4.5 vs 4.5; HR 3.45, 95% CI 2.22-5.36, P < .001), and cancer antigen 19-9 (CA19-9) (≥900 vs <900 U/mL; HR 1.45, 95% CI 1.02-2.05, P = .036) were independent prognostic factors. In those receiving palliative care alone, lung (HR 3.27, 95% Cl 1.46-7.35, p = 0.004) and peritoneum (HR 2.50, 95% CI 1.20-5.18, P = .014) metastases and the C-reactive protein-to-albumin ratio (≥1.3 vs <1.3; HR 3.33, 95% Cl 1.51-7.35, P = .003) were independent prognostic factors. Furthermore, patients with multiple factors had worse prognosis in both groups. Median survival time of palliative chemotherapy patients with risk factors 0, 1, 2, and 3 were 13.1 (95% CI 8.0-16.9), 9.4 (95% CI 7.9-10.1), 6.6 (95% CI 4.9-7.8), and 2.5 (95% CI 1.7-4.0) months, respectively. Similarly, median survival time was 5.7 (95% CI 1.3 -8.0), 2.1 (95% CI 1.5-3.9), and 1.3 (95% CI 0.6-1.7) months, respectively, for palliative care alone patients with risk factor 0, 1, and 2 to 3.Prognostic markers for pancreatic cancer were neutrophil-to-lymphocyte ratio, liver metastasis, and CA19-9 in patients undergoing palliative chemotherapy and C-reactive protein-to-albumin ratio and lung/peritoneum metastases in patients undergoing palliative care alone. These simple markers should be considered when explaining the prognosis and therapeutic options to patients.

Pretherapeutic factors predicting conversion surgery in unresectable pancreatic ductal adenocarcinoma: A retrospective study

“…NLR is a leading inflammation-related marker in various cancers and is valuable for predicting the prognosis of UR-PDAC (26)(27)(28). LMR also predicts poor outcomes in patients with UR-PDAC undergoing chemotherapy (29).…”

Clinical and biological markers predictive of treatment response associated with metastatic pancreatic adenocarcinoma

“…While chemotherapy currently represents the only treatment option associated with an extension in OS, treatment-related toxicity, impact on quality of life and limited survival gains means that selecting appropriate patients for intervention is challenging. Reliable prognostic markers, as well as markers predictive of response to chemotherapy, could potentially aid patient management but are currently lacking [ 5 , 6 ]. In clinical practice, poor performance status (using either the Eastern Cooperative Oncology Group [ECOG PS] or Karnofsky [KPS] scales) and the presence of liver metastases are known to predict for poor disease outcomes [ 3 , 7 ], but also characterise the majority of patients diagnosed with metastatic PDAC.…”

Alternative Splicing Events in Immune Infiltration of Lung Adenocarcinoma

“…LUAD tissues exhibit more aberrant activation patterns of AS; however, the exact role of AS in lung cancer is unknown [ 5 ]. In recent years, epigenetic and transcriptomic studies have identified many valuable tumor markers that may provide new ideas for future diagnosis and treatment [ 6 – 8 ]. Immune response affects tumor development and sensitivity to drugs, while AS influences the type and function of immune cells [ 9 , 10 ].…”