Abstract
Background We investigated the prognostic usefulness of prechemoradiotherapy (CRT) albumin-to-alkaline phosphatase ratio (AAPR) in unresectable locally advanced pancreatic adenocarcinoma (LAPAC) patients managed with definitive concurrent CRT (CCRT). Methods A sum of 136 LAPAC patients who consecutively underwent definitive CCRT was retrospectively analyzed. The AAPR (serum albumin (g/dL)/serum alkaline phosphatase (IU/L)) was calculated by using the parameters obtained from the routine biochemistry tests on the first day of the CCRT. Ideal AAPR cutoff was sought by utilizing receiver operating characteristic (ROC) curve analysis. The primary and secondary endpoints were the impact of the AAPR on the overall survival (OS) and progression-free survival (PFS) results, respectively. Results At a median follow-up of 14.8 months (range: 3.2-85.7), the median PFS and OS times were 7.5 (95% confidence interval (CI): 6.0-9.0) and 14.9 months (95% CI: 11.9-17.9), respectively. The ideal common AAPR cutoff was identified at the rounded 0.46 (area under the curve: 72.3%; sensitivity: 71.2%; specificity: 70.3%) point that dichotomized the patients into two groups: low AAPR (L-AAPR; N = 71) and high AAPR (H-AAPR; N = 65) groups, respectively. Comparative survival analyses showed that the L-AAPR cohort had significantly shorter median PFS (6.8 (95% CI: 5.7-7.9) versus 11.3 (95% CI: 9.9-12.7) months; P = 0.005) and OS (12.8 (95% CI: 10.6-15.0) versus 19.2 (95% CI: 16.9-21.5) months; P = 0.001) durations than their H-AAPR counterparts, separately. Albeit the N1-2 (P = 0.004) and CA 19‐9 > 90 U/mL (P = 0.008) were also found to be associated with inferior outcomes, yet the results of the multivariate analyses ascertained the L-AAPR as an independent indicator of diminished PFS (P = 0.003) and OS (P = 0.002) results. Conclusion The present results proposed that the pretreatment AAPR < 0.46 was a novel independent indicator of adverse PFS and OS in unresectable LAPAC patients undergoing definitive CCRT.
Highlights
Pancreatic adenocarcinoma (PAC) represents one of the poorest prognostic cancers with respective estimated median and 5-year overall survival (OS) rates of less than 12 months and 10% [1, 2]
We found that CA 19‐9 > 90 U/mL, N1-2 nodal stage, and LAAPR were the variables to reveal significantly inferior OS (P < 0:05, for each) and progression-free survival (PFS) (P < 0:05, for each) outcomes, separately (Table 2)
In our current investigation, contrasted to their H-alkaline phosphatase ratio (AAPR) counterparts, the unresectable locally advanced pancreatic adenocarcinoma (LAPAC) patients presenting with low AAPR (L-AAPR) had poorer median and long-term PFS and OS independent of other confounding factors following conclusive concurrent CRT (CCRT)
Summary
Pancreatic adenocarcinoma (PAC) represents one of the poorest prognostic cancers with respective estimated median and 5-year overall survival (OS) rates of less than 12 months and 10% [1, 2]. Comparable anticancer interventions in equivalent LAPAC stages may end up with significantly different clinical results These critical contrasts are, to a large extent, related to the conventional use of the TNM (tumornode-metastasis) staging system as the most trusted prognostic tool in such patients, which dismisses the substantial tumor- and host-related biological differences by depending solely upon the local and regional expansions of the index LAPAC. Such enormous contrasts in the same stage after equivalent treatments undoubtedly emphasize. The present results proposed that the pretreatment AAPR < 0:46 was a novel independent indicator of adverse PFS and OS in unresectable LAPAC patients undergoing definitive CCRT
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