Effect of glucose lymphocyte ratio on prognosis in patients operated with the diagnosis of pancreatic adenocarcinoma

Abstract

Aims: Pancreatic adenocarcinoma is one of the most aggressive cancers, and predicting prognosis and survival clinically is challenging. Prognostic markers, easily accessible and routinely evaluated in diagnostic tests, are frequently seen in the literature for survival prediction. So far, the glucose lymphocyte ratio (GLR) has emerged as an indicator that can assess both metabolic dysregulation and immune response. In this study, the aim was to assess the impact of GLR on prognosis and survival by following patients diagnosed with pancreatic adenocarcinoma who underwent surgery. Methods: Between January 1, 2016, and April 31, 2021, a totalof 58 patients who underwent Whipple procedure due to pancreatic adenocarcinoma at the Department of General Surgery, Hitit University, were included in the study. Demographic characteristics, tumor features, laboratory results, and survival durations of the patients were collected. GLR was determined as a mortality predictor, and estimated survival times associated with GLR were determined using Kaplan-Meier Survival analysis. The optimal GLR value was determined through ROC analysis. Results: During the postoperative period, the average follow-up time for patients was 11.39 months, with the longest follow-up time being 48 months. During this period, 43 patients (74.14%) were deceased, while 15 patients (25.86%) survived. The mean age and ASA scores of deceased patients were significantly higher compared to survivors (p<0.001 and p<0.001, respectively). Glucose levels were significantly higher in the mortality group compared to the survival group (p=0.008). GLR was notably higher in the mortality group (p=0.170; p=0.703; p=0.429; and p=0.031). The GLR value that best distinguished the two groups was found to be 94.6387 with 93.3% specificity and 95.8% positive predictive value. Crossing this threshold increased the mortality risk approximately 4.27 times within one year and increased the overall mortality risk by approximately 15 times (p=0.014 and p=0.002). The estimated life expectancy for patients below the threshold value was calculated to be an average of 20.996 months, whereas for patients above the threshold value, this expectation was calculated to be an average of 4.427 months (p<0.001). Conclusion: We believe that GLR may be helpful in predicting one-year survival and determining overall survival duration in patients undergoing surgery for pancreatic adenocarcinoma.