Abstract
Backround: Surgical resection is the best option for patients with pancreatic ductal adenocarcinoma (PDAC) stage I and II. At the time of diagnosis many of apparently resectable tumors are in more advanced stages, and pancreatic cancer must be considered as systematic disease. Determination of pre-operative prognostic factors for 6 months postoperative mortality may improve patients’ selection for surgical resection. Methods: Retrospective review of the Pancreatic Cancer database was performed and patients who underwent radical surgery for adenocarcinoma of the pancreatic head between 2005 and 2015 were included. Khorana score (KS) and inflammatory burden markers- neutrophil-lymphocyte ratio (NLR), lymphocyte- monocyte ratio (LMR), thrombocyte-lymphocyte ratio (PLR) were calculated. The retrieved data was analyzed using SPSS 21.0 A p value <0.05 was concidered significant. The retrospective study was reviewed and approved by Ethics committee. Results: 187 patients were included in the study. Median survival was 13 months, and the 6-month mortality rate 23.4%. Forty-seven patients were classified as high risk according to KS (≥3), with no statistical significance of these patients dying during 6 months following surgery (p=0.158). The postoperative survival was better in LMR>3 group (28±5.1 vs 16.3±2.6 months) and in PLR<150 group (29.1±4.3 vs 25.5±3.9 months), however, no statistically significant difference was found. Patients in NLR<5 group had statistically significant higher rate of survival after pancreatic resection (86.7% vs 13.3%, p=0.05) in a period of six months. We found that NLR>5 (HR: 1.833; 95% Cl: 0.890-3.774, p=0.1) and LMR<3 (HR: 1.316; 95% Cl: 0.535-3.240, p=0.5) might predict early death, however without statistical significance. Conclusions: Marker of inflammatory burden NLR<5 appeared to be useful prognosing increased 6 months survival and longer overall postoperative survival following surgery for PDAC. However, possibly due to insufficient number of patients, we were unable to prove statistical significance in other inflammatory markers and KS.
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