Peripheral Blood Lymphocyte Percentage May Predict Chemotolerance and Survival in Patients with Advanced Pancreatic Cancer. Association between Adaptive Immunity and Nutritional State.

Roberto Aquilani,Roberto Maestri,Annalisa Barbieri,Federica Boschi,Maurizia Dossena,Beatrice Filippi,Lorenzo Perrone,Manuela Verri,Daniela Buonocore,Silvia Brugnatelli

doi:10.3390/curroncol28050285

Abstract

Simple SummaryAlterations of the immune system that consist of induced inflammation and reduction in blood lymphocytes are a major factor contributing to cancer progression in patients with pancreatic carcinoma (PC). Identification of the percentage of lymphocytes in the Total number of White Blood Cells (L% TWBC) that could be associated with chemotolerance and survival time may be important for predicting treatment efficacy. The aim of this retrospective study was to highlight the best value of L% for predicting chemotolerance (n° of cycles tolerated) and survival beyond 12 months from diagnosis. The study found that L ≥ 29.7% TWBC compared to L < 29.7% predicted chemotolerance (p < 0.0001) and survival at every time point of follow-up: 6 (p = 0.04), 12 (p = 0.0003) and 18 months (p = 0.004) after diagnosis. Simple, rapid, routine laboratory data can be useful to predict treatment tolerance and efficacy in PC patients.Pancreatic Carcinoma (PC) cells have the ability to induce patient immunosuppression and to escape immunosurveillance. Low circulating lymphocytes are associated with an advanced stage of PC and reduced survival. Blood lymphocytes expressed as a percentage of Total White Blood Cells (L% TWBC) could predict chemotolerance (n° of tolerated cycles), survival time and Body Weight (BW) more effectively than lymphocytes expressed as an absolute value (LAB > 1500 n°/mm3) or lymphocytes >22%, which is the lowest limit of normal values in our laboratory. Forty-one patients with advanced PC, treated with chemotherapy, were selected for this observational retrospective study. Patients were evaluated at baseline (pre-chemotherapy), and at 6, 12 and 18 months, respectively, after diagnosis of PC. The study found L ≥ 29.7% to be a better predictor of survival (COX model, using age, sex, BW, serum creatinine, bilirubin and lymphocytes as covariates), chemotolerance (r = +0.50, p = 0.001) and BW (r = +0.35, p = 0.027) than LAB > 1500 or L > 22%. BW did not significantly correlate with chemotolerance or survival. The preliminary results of this study suggest that L ≥ 29.7% is more effective than LAB > 1500 or L > 22% at predicting chemotolerance, survival time and nutritional status. A possible impact of nutritional status on chemotherapy and survival seems to be lymphocyte-mediated given the association between BW and L%. This study may serve as the basis for future research to explore whether nutritional interventions can improve lymphopenia, and if so, how this may be possible.

Highlights

Pancreatic cancer (PC) is a highly aggressive malignancy with a poor prognosis for patients
Most PC patients die within the first year after diagnosis [2–4] and the 5-year survival rate is less than 10% [5,6]
The second objective of the study was to document the relationship between body weight (BW)—an indicator of good health—and circulating neutrophil counts (NAB), lymphocytes expressed in absolute values (LAB), neutrophil/lymphocyte ratio (N/L), chemotolerance and survival

Summary

Introduction

Pancreatic cancer (PC) is a highly aggressive malignancy with a poor prognosis for patients. PC is the fourth most important cause of death worldwide [1]. Most PC patients die within the first year after diagnosis [2–4] and the 5-year survival rate is less than 10% [5,6]. In our country (Italy), the survival rate is 8.1% at 5 years and 3% at 10 years after diagnosis [7]. Surgery is the most important therapeutic option for localized PC. Despite the progress made in recent decades, the recurrence rate five years after resection is 80%, and the survival rate is 22% [8,9]

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