Abstract
BackgroundGrowing evidence indicates that the systemic inflammatory response plays an important role in cancer development and progression. Several inflammatory markers have been reported to be associated with clinical outcomes in patients with various types of cancer. This study was designed to evaluate the prognostic value of inflammatory indexes in patients with ampullary cancer (AC) who underwent pancreaticoduodenectomy (PD).MethodsWe retrospectively reviewed the data of 358 patients with AC who underwent PD between 2009 and 2018. R software was used to compare the area under the time-dependent receiver operating characteristic (ROC) curves (AUROCs) of the inflammation-based indexes, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), modified Glasgow Prognostic Score (mGPS), prognostic nutritional index (PNI) and prognostic index (PI), in terms of their predictive value for survival. The survival differences of these indexes were compared by the Kaplan-Meier method and univariate and multivariate analyses were performed to determine the prognostic factors of disease-free survival (DFS) and overall survival (OS).ResultsThe estimated 1-, 2-, and 3-year OS and DFS rates were 83.9, 65.8, and 55.2% and 58.0, 42.8, and 37.8%, respectively, for the entire cohort. The survival differences were significant in terms of OS and DFS when patients were stratified by these inflammation-based indexes. The comparisons of the AUROCs of these inflammation-based indexes illustrated that NLR and PI displayed the highest prognostic value, compared to the other indexes. When NLR and PI were combined, NLR-PI showed even higher AUROC values and was identified as a significant prognostic factor for OS and DFS.ConclusionSpecific inflammatory indexes, such as NLR, PLR and dNLR, were found to be able to predict the OS or DFS of patients. As a novel inflammatory index, the level of NLR-PI, which can be regarded as a more useful prognostic index, exhibited strong predictive power for predicting the prognosis of patients with AC after the PD procedure.
Highlights
Growing evidence indicates that the systemic inflammatory response plays an important role in cancer development and progression
A total of 358 patients who were diagnosed with ampullary cancer (AC) and underwent the Whipple procedure as curative resection were included in the final analysis
We systematically demonstrated the prognostic significance of preoperative inflammatory parameters, including neutrophil-to-lymphocyte ratio (NLR), derived neutrophilto-lymphocyte ratio (dNLR), platelet-tolymphocyte ratio (PLR), modified Glasgow Prognostic Score (mGPS), prognostic index (PI) and prognostic nutritional index (PNI), for predicting prognosis in a cohort of 358 patients who suffered from AC and had underwent the Whipple procedure as curative resection
Summary
Growing evidence indicates that the systemic inflammatory response plays an important role in cancer development and progression. Several inflammatory markers have been reported to be associated with clinical outcomes in patients with various types of cancer. This study was designed to evaluate the prognostic value of inflammatory indexes in patients with ampullary cancer (AC) who underwent pancreaticoduodenectomy (PD). Due to the specific anatomical structure and biliary obstruction, distinctive clinical symptoms usually arise in patients at an early stage, so operative treatments are available. Several studies have reported that few parameters, such as the symptoms and general state of the patients, tumour size, pathological grade, lymphatic metastasis and carbohydrate antigen 19–9 (CA19–9) levels, are related to the survival rate, they were not sufficiently powerful. A better predictive index for the survival time and risk of recurrence of patients with postoperative ampullary carcinoma is essential
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