Abstract
Introduction: Several nutritional and inflammatory markers have been reported to be involved in cancer progression. The aim of this study is to evaluate whether nutritional and inflammatory biomarkers such as the Glasgow prognostic score (GPS), the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the systemic-immune-inflammation index (SIII), controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and the lymphocyte-to-monocyte ratio (LMR) could predict the prognosis in patients with locally advanced unresectable pancreatic ductal adenocarcinoma (UR-LA PDAC) who underwent chemotherapy as first-line therapy, using disease-specific survival as the primary outcome. Method: All UR-PDAC patients were retrospectively evaluated between January 2011 and May 2017 at Toyama University Hospital. Baseline clinicopathological characteristics and pre-treatment laboratory values such as absolute neutrophil, lymphocyte and platelet counts, C-reactive protein, albumin and CA19-9 levels, were collected. Result: A total of 175 patients were diagnosed as UR-PDAC, and 36 patients were diagnosed as UR-LA PDAC. Among them, 34 patients who underwent chemotherapy were enrolled in this study. There were significant relationships between poor survival and elevated GPS, elevated PLR, decreased PNI, elevated SIII, decreased LMR, and low CONUT score (p=0.008, p=0.002, p=0.019, p=0.001, p=0.039, and p=0.038, respectively, by log-rank test). The median survival time of patients with GPS score of 0-1 was significantly longer than that of patients with GPS score of 2 (23.7 vs 13.4 months, respectively). There was no significant difference in survival in pre-treatment CA19-9 level, tumor location, maximum tumor diameter, and additional radiotherapy. Multivariate analysis using Cox regression model revealed that GPS was an independent prognostic factor. Conversion surgery was performed after successful downstaging in 4 patients (12%). Conclusion: Pre-treatment GPS may predict clinical outcome in patients with UR-LA PDAC undergoing chemotherapy as first-line therapy.
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