Abstract
The purpose was aimed to establish a simple computational model to predict tumor prognosis by combining neutrophil to lymphocyte Ratio (NLR) and biomarkers of oncological characteristics in patients undergoing vascular reconstructive radical resection of PDAC. The enrolled patients was divided into high or low NLR group with the cutoff value determined by the receiver operator characteristic (ROC) curve. Different vascular anastomoses were selected according to the Chaoyang classification of PDAC. Survival rates were calculated using the Kaplan-Meier and evaluated with the log-rank test. Cox risk regression model was used to analyze the independent risk factors for prognostic survival. The optimal cut-off value of NRL was correlated with the differentiation, tumor size, TNM stage and distant metastasis of advanced PDAC. A curative resection with vascular reconstructive of advanced PDAC according to Chaoyang classification can obviously improve the survival benefits. Cox proportional hazards demonstrated higher evaluated NLR, incisal margin R1 and lymphatic metastasis were the independent risk predictor for prognosis with the HR > 2, meanwhile, age beyond 55, TNM stage of III-IV or Tumor size > 4cm were also the obvious independent risk predictor for prognosis with the HR ≤ 2. The advanced PADC patients marked of RS group (3 < RS ≤ 6) showed no more than 24 months of survival time according to RS model based on the six independent risk predictors. Vascular reconstruction in radical resection of advanced PDAC improved survival, higher elevated NLR (>2.90) was a negative predictor of DFS and OS in those patients accompanying portal system invasion.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) accounts for more than 90% [1] of all pancreatic cancer which is fifth most common cancers around the world [2]
The enrolled patients were divided into high neutrophil to lymphocyte Ratio (NLR) group and low NLR group according to the cutoff value. 118 patients (49%) identified as high NLR group had an elevated NLR (> 2.9), and 123 patients (51%) were identified as low NLR (≤ 2.9) group
The diagnostic value of high NLR in patients with negative CA19-9 indicators still needs to be verified in a large sample. These results demonstrated that high NLR has a worse survival for advanced PDAC after curative excision with vascular resection and reconstruction
Summary
Pancreatic ductal adenocarcinoma (PDAC) accounts for more than 90% [1] of all pancreatic cancer which is fifth most common cancers around the world [2]. Radical resection, including thorough lymph node dissection, is an effective means to improve prognosis and survival. SMV and PV are the most vulnerable and frequent to invasion because of the proximity of these vessels to the uncinate process and pancreatic head [10]. These patients may have a rather low median survival of 8 months compared with there were no vascular invasion [11]. Radical resection of pancreatic cancer combined with complete vascular resection and reconstruction of the PV-SMV venous axis in these patients is a possible approach. Vascular invasion as a prognostic factor was carried out in several studies which mainly focus on whether there is an association between vascular invasion and poor prognosis, the types of vascular invasion, classification (location, depth and circumference) and anastomotic techniques of vascular reconstruction on the prognosis is not clear
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
