Stratification of Prognosis in Patients With Ampullary Carcinoma After Surgery by Preoperative Platelet-to-lymphocyte Ratio and Conventional Tumor Markers

Abstract

Background/Aim: The platelet-to-lymphocyte ratio (PLR) has recently been suggested as a new predictor of the prognosis in several carcinoma types. However, the clinical impact remains controversial in patients with ampullary carcinoma. Thus, the aim of this study was to investigate other useful biomarkers for identifying poor prognosis in patients with ampullary carcinoma. Patients and Methods: Forty-one patients with ampullary carcinoma underwent pancreaticoduodenectomy (PD) with curative resection between April 2000 and April 2017. Various clinicopathological findings of the patients and their tumors were evaluated as potential prognostic factors which might enable better stratification of prognosis. Results: Platelet-to-lymphocyte ratio, as well as other markers, was found to be a prognostic factor in patients with ampullary carcinoma. The 2-year disease-free survival percentage was significantly higher in the group with low PLR than in the high PLR group (70.2% vs. 28.6%; p=0.005) . Combinational analysis of the PLR and conventional TMs enabled us to stratify prognosis of the patients more clearly than by each marker alone. Conclusion: PLR was a useful prognostic factor for patients with ampullary cancer. The combination of preoperative PLR and conventional TMs markers may be powerful predictive factors for postoperative prognosis in patients with ampullary carcinoma following PD.Ampullary carcinoma is extremely rare, accounting for approximately 0.2-0.5% of all gastrointestinal malignancies and approximately 6-17% of periampullary tumors (1-4). The most commonly recommended treatment is pancreaticoduodenectomy (PD), which has a reported resectability rate of 82.1% (1). Although ampullary carcinoma is considered to have a better prognosis [5-year survival rate of 30% to 60% (1, 5, 6)] than other peripancreatic head adenocarcinomas, some cases have a poor prognosis with early recurrence.Several prognostic factors have been reported in ampullary carcinoma, including lymph node metastasis (1, 7-10), depth of tumor infiltration (2, 9), tumor stage (3, 10), involvement of resection margins (5), lymphatic vessel invasion (7), perineural invasion (8), and pancreaticobiliary subtype (4, 10, 11). However, accurate information for these factors are generally obtained postoperatively.In recent years, biomarkers have been suggested as new prognostic factors in several cancer types. Of these, the lymphocyte-to-monocyte ratio (LMR), neutrophil-tolymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) have been studied extensively and adopted as predictors of prognosis in other diseases (12-25). However, in ampullary carcinoma, the roles of these biomarkers remain controversial, as the presence of this disease is relatively rare and blood-based biomarkers may be affected by comorbidities, such as obstructive jaundice and cholangitis.Based on this, we evaluated preoperative LMR, NLR, and PLR as prognostic factors for ampullary carcinoma in patients free of obstructive jaundice and cholangitis. Furthermore, in order to...

Novel prognostic score based on the preoperative total bilirubin-albumin ratio and fibrinogen-albumin ratio in ampullary adenocarcinoma

“…During tumor growth, tumor markers are produced and released into the blood circulation, which can be used for the diagnosis and monitoring of tumors. However, sensitive tumor markers are still lacking for predicting survival and treatment outcomes in AC[ 26 ]. In recent years, liquid biopsies have been increasingly emphasized.…”

Preoperative CA19-9 and GGT ratio as a prognostic indicator in ampullary carcinoma

“…A series of scores based on in ammatory factors have been used as convenient and feasible prognostic indicators for various malignant tumors in the past decade (22)(23)(24) . However, due to the rareness of ampullary carcinoma and the possibility of being affected by coexisting diseases, such as obstructive jaundice and cholangitis, the predictive value of these in ammation-based scores is less reliable (1,(12)(13)(14)19) . This study is the rst attempt to use this prognostic indicator of CA19-9 to GGT ratio to predict the prognosis and survival of patients with ampullary carcinoma after radical resection.…”

“…In the past decade, the in ammation-based scores have emerged as novel prognostic indexes for a variety of malignant tumors (12)(13)(14)(15)(16)(17)(18)(19)(20) , such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and has been favored by more and more scholars. However, the predictive value of these in ammation-based scores remains controversial (12)(13)(14)19) . In view of the above considerations, CA19-9/GGT ratio was used to evaluate whether it will become a simple, accessible, and more predictive prognostic indicator for AC patients after radical resection.…”

“…In the past decade, the in ammation-based scores have emerged as novel prognostic indexes for a variety of malignant tumors (12)(13)(14)(15)(16)(17)(18)(19)(20) , such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and has been favored by more and more scholars. However, the predictive value of these in ammation-based scores remains controversial (12)(13)(14)19) .…”

Evolution of Treatment of Cancer of the Major Duodenal Papilla

“…Наблюдения, где в течение года после ПДР выявляли рецидив болезни, не отмечали 5-летней выживаемости [34][35][36]. Соотношение тромбоцитов к лимфоцитам (PLR, platelet-to-lymphocyte ratio) является прогностическим фактором при раке БСДК [37]. В группе с низким PLR 2-летняя безрецидивная выживаемость была достоверно выше, чем при высоком PLR, -70,2 % против 28,6 % (р=0,005).…”