P-286 Prognostic factors for pancreatic adenocarcinoma: Prognostic nutritional index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio

Abstract

Pancreatic cancer is the seventh most deadly cancer worldwide with 495,773 new diagnosis and 466,003 deaths according to Globocan 2020. Despite increase on diagnosis and new therapeutic options available during last decade, 5-year survival rate for all stages remains poor both for early and metastatic disease. Nutritional and inflammatory status play an important role during pancreatic carcinogenesis, leading to an increasing interest on novel cost-effective biomarkers that access this status and predict prognosis. Prognostic Nutritional Index (PNI), Neutrophile to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) have been used as surrogates for nutritional and inflammatory status. Retrospective unicentric observational study of the prognostic impact of Prognostic Nutritional Index (PNI), Neutrophile/Lymphocyte Ratio (NLR) and Platelet/Lymphocyte Ratio (PLR) on all stage pancreatic adenocarcinomas diagnosed between January/15 and December/21. PNI calculated as “10xserum albumin(g/dL) + 0,005xtotal lymphocyte count(mm3)”, NRL as “total neutrophile count/total lymphocyte count” and PLR as “total platelet count/ total lymphocyte count”. Cut-off points calculated by receiver-operating curves (ROC analysis), correlations accessed using univariate Cox regression and Kaplan-Meier survival curves. 123 patients were diagnosed with pancreatic adenocarcinoma, 48%(n=60) women and 52% (n=64) men with a median age of 71 (37-98) years and ECOG of 1 (0-4). At diagnosis, 31% (n=39) presented with resectable disease, 2% (n=2) with borderline resectable, 15% (n=18) unresectable and 52% (n=64) with metastatic disease. For PNI, non-metastatic disease was stratified by a cut-off point of 35.0 with an overall survival (OS) of 11 (4-17) months for PNI>35 and 7 (1-14) months for PNI≤ 35 (p=0,032). Median time to progression of 10 (8-13) months for PNI>35 and 6 (1-10) months for PNI≤ 35 (p=0,04). No significant cut-off value for PNI was found for metastatic disease or general population. Regarding NLR, general population was stratified by a cut off point of 0.25, with OS of 4 (1-7) months for NLR≤0.25 and 11 (7-14) months for NLR>0.25 (p=0.05). Metastatic disease at diagnosis with NLR≤0.25 presented an OS of 3(1-6) months and for NLR>0.25 of 8(6-10) months (p=0,05). For PLR, general population with a PLR≤200.5 had an OS of 8(5-11) months and PLR>200.5 of 3(1-5) months (p=0,01). Time to progression for PLR≤179.5 of 9(5-11) months and 5 (3-7) months for PLR>179.5 (p=0,04). Metastatic disease with PLR≤179.5 had an OS of 8 (1-15) months and PLR>179.5 of 4(2-6) months (p=0,03). non-metastatic disease with PLR≤200.5 had an OS of 11(7-11) months and 2 (1-4) months for PLR>200.5 (p=0,03). Real-world data assessed demonstrates an association of higher levels of PNI with better overall survival and progression free survival. Inflammatory status assessed by NLR and PLR also showed a significant impact on both overall survival and progression free survival. Therefore, this real-world series adds evidence to the value of PNI, NLR and PLR as surrogates of nutritional and inflammatory status and its clinical relevance for pancreatic adenocarcinoma.