Skip to main content

Advertisement

SpringerLink
Log in

Prognostic Value of Preoperative Nutritional and Immunological Factors in Patients with Pancreatic Ductal Adenocarcinoma

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Preoperative nutritional and immunological patient factors have been found to be associated with prognostic outcomes of malignant tumors; however, the clinical significance of these factors in pancreatic ductal adenocarcinoma (PDAC) remains controversial.

Objective

The aim of this study was to evaluate the prognostic value of nutritional and immunological factors in predicting survival of patients with PDAC.

Methods

Retrospective studies of 329 patients who underwent surgical resection for PDAC and 95 patients who underwent palliative surgery were separately conducted to investigate the prognostic impact of tumor-related factors and patient-related factors, including Glasgow Prognostic Score (GPS), modified GPS, Prognostic Nutritional Index (PNI), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, and lymphocyte/monocyte ratio.

Results

In multivariate analysis for patients with surgical resection for PDAC, PNI was an independent factor for overall survival (OS) and disease-free survival. The median OS of patients with PNI ≤ 45 was significantly shorter than that of patients with PNI > 45 (17.5 and 36.2 months, respectively; p < 0.001). In multivariate analysis for patients undergoing palliative surgery for PDAC, only NLR was an independent prognosis factor. The median OS of patients with NLR > 5 was significantly shorter than that of patients with NLR ≤ 5 (2.7 and 8.9 months, respectively; p < 0.001).

Conclusions

PNI in patients with surgical resection and NLR in patients with palliative surgery for PDAC may be useful prognostic factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30. http://doi.org/10.3322/caac.21442.

    Article  PubMed  Google Scholar 

  2. Conlon KC, Klimstra DS, Brennan MF. Long-term survival after curative resection for pancreatic ductal adenocarcinoma. Clinicopathologic analysis of 5-year survivors. Ann Surg. 1996;223(3):273–9. http://doi.org/10.1097/00000658-199603000-00007.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Brennan M, Kattan M, Klimstra D, Conlon K. Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg. 2004;240(2):293–8. http://doi.org/10.1097/01.sla.0000133125.85489.07.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Vakkila J, Lotze MT. Opinion: Inflammation and necrosis promote tumour growth. Nat Rev Immunol. 2004;4(8):641–8. http://doi.org/10.1038/nri1415.

    Article  CAS  PubMed  Google Scholar 

  5. Ben Q, An W, Wang L, Wang W, Yu L, Yuan Y. Validation of the pretreatment neutrophil-lymphocyte ratio as a predictor of overall survival in a cohort of patients with pancreatic ductal adenocarcinoma. Pancreas. 2015;44(3):471–7. http://doi.org/10.1097/MPA.0000000000000271.

    Article  CAS  PubMed  Google Scholar 

  6. Jamieson NB, Denley SM, Logue J, et al. A prospective comparison of the prognostic value of tumor- and patient-related factors in patients undergoing potentially curative surgery for pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2011;18(8):2318–28. http://doi.org/10.1245/s10434-011-1560-3.

    Article  PubMed  Google Scholar 

  7. La Torre M, Nigri G, Cavallini M, Mercantini P, Ziparo V, Ramacciato G. The glasgow prognostic score as a predictor of survival in patients with potentially resectable pancreatic adenocarcinoma. Ann Surg Oncol. 2012;19(9):2917–23. http://doi.org/10.1245/s10434-012-2348-9.

    Article  PubMed  Google Scholar 

  8. Sierzega M, Lenart M, Rutkowska M, et al. Preoperative Neutrophil-Lymphocyte and Lymphocyte-Monocyte Ratios Reflect Immune Cell Population Rearrangement in Resectable Pancreatic Cancer. Ann Surg Oncol. 2017;24(3):808–15. http://doi.org/10.1245/s10434-016-5634-0.

    Article  PubMed  Google Scholar 

  9. Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg. 2011;98(2):268–74. http://doi.org/10.1002/bjs.7305.

    Article  CAS  PubMed  Google Scholar 

  10. Sugiura T, Uesaka K, Kanemoto H, Mizuno T, Okamura Y. Elevated Preoperative neutrophil-to-lymphocyte ratio as a predictor of survival after gastroenterostomy in patients with advanced pancreatic adenocarcinoma. Ann Surg Oncol. 2013;20(13):4330–7. http://doi.org/10.1245/s10434-013-3227-8.

    Article  PubMed  Google Scholar 

  11. Abe T, Ohuchida K, Endo S, et al. Clinical importance of intraoperative peritoneal cytology in patients with pancreatic cancer. Surg (United States). 2017;161(4):951–8. http://doi.org/10.1016/j.surg.2016.10.035.

    Article  Google Scholar 

  12. McMillan DC, Elahi MM, Sattar N, Angerson WJ, Johnstone J, McArdle CS. Measurement of the systemic inflammatory response predicts cancer-specific and non-cancer survival in patients with cancer. Nutr Cancer. 2001;41(1–2):64–9. http://doi.org/10.1080/01635581.2001.9680613.

    Article  CAS  PubMed  Google Scholar 

  13. McMillan DC, Crozier JEM, Canna K, Angerson WJ, McArdle CS. Evaluation of an inflammation-based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer. Int J Colorectal Dis. 2007;22(8):881–6. http://doi.org/10.1007/s00384-006-0259-6.

    Article  PubMed  Google Scholar 

  14. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients [in Japanese]. Nippon Geka Gakkai Zasshi. 1984;85:1001–5.

    CAS  PubMed  Google Scholar 

  15. Shirai Y, Shiba H, Sakamoto T, et al. Preoperative platelet to lymphocyte ratio predicts outcome of patients with pancreatic ductal adenocarcinoma after pancreatic resection. Surgery. 2015;158(2):360–5. http://doi.org/10.1016/j.surg.2015.03.043.

    Article  PubMed  Google Scholar 

  16. Wang DS, Luo HY, Qiu MZ, et al. Comparison of the prognostic values of various inflammation based factors in patients with pancreatic cancer. Med Oncol. 2012;29(5):3092–100. http://doi.org/10.1007/s12032-012-0226-8.

    Article  CAS  PubMed  Google Scholar 

  17. Lee SH, Chung MJ, Kim B, et al. The significance of the prognostic nutritional index for all stages of pancreatic cancer. Nutr Cancer. 2017;69(3):512–9. http://doi.org/10.1080/01635581.2016.1250921.

    Article  CAS  PubMed  Google Scholar 

  18. Stotz M, Gerger A, Eisner F, et al. Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer. Br J Cancer. 2013;109(2):416–21. http://doi.org/10.1038/bjc.2013.332.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Ray-Coquard I, Cropet C, Van Glabbeke M, et al. Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas. Cancer Res. 2009;69(13):5383–91. http://doi.org/10.1158/0008-5472.CAN-08-3845.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Laky B, Janda M, Bauer J, Vavra C, Cleghorn G, Obermair A. Malnutrition among gynaecological cancer patients. Eur J Clin Nutr. 2007;61(5):642–6. http://doi.org/10.1038/sj.ejcn.1602540.

    Article  CAS  PubMed  Google Scholar 

  21. Nozoe T, Kohno M, Iguchi T, et al. The prognostic nutritional index can be a prognostic indicator in colorectal carcinoma. Surg Today. 2012;42(6):532–5. http://doi.org/10.1007/s00595-011-0061-0.

    Article  PubMed  Google Scholar 

  22. Nozoe T, Ninomiya M, Maeda T, Matsukuma A, Nakashima H, Ezaki T. Prognostic nutritional index: A tool to predict the biological aggressiveness of gastric carcinoma. Surg Today. 2010;40(5):440–3. http://doi.org/10.1007/s00595-009-4065-y.

    Article  PubMed  Google Scholar 

  23. Kanda M, Mizuno A, Tanaka C, et al. Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer. Med (Baltimore). 2016;95(24):e3781. http://doi.org/10.1097/MD.0000000000003781.

    Article  CAS  PubMed Central  Google Scholar 

  24. Martin L, Birdsell L, MacDonald N, et al. Cancer cachexia in the age of obesity: Skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539–47. http://doi.org/10.1200/JCO.2012.45.2722.

    Article  PubMed  Google Scholar 

  25. Okumura S, Kaido T, Hamaguchi Y, et al. Impact of preoperative quality as well as quantity of skeletal muscle on survival after resection of pancreatic cancer. Surg (United States). 2015;157(6):1088–1098. http://doi.org/10.1016/j.surg.2015.02.002.

    Article  Google Scholar 

Download references

Acknowledgment

This work was supported in part by a Japan Society for the Promotion of Science Grant-in-Aid for Fellows (No. 16J03962), Scientific Research (B) [Nos. 17H04284, 16H05417, 16H05418] and (C) [No. 16K10601], and Scientific Research on Innovative Areas (Nos. 17K19602, 17K19605). The authors thank Mary Derry, Ph.D. ELS, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Author information

Authors and Affiliations

  1. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Toshiya Abe MD, PhD, Kohei Nakata MD, PhD, Shin Kibe MD, Yasuhisa Mori MD, PhD, Yoshihiro Miyasaka MD, PhD, Kenoki Ohuchida MD, PhD, Takao Ohtsuka MD, PhD & Masafumi Nakamura MD, PhD

  2. Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Yoshinao Oda MD, PhD

Authors
  1. Toshiya Abe MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kohei Nakata MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shin Kibe MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yasuhisa Mori MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoshihiro Miyasaka MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenoki Ohuchida MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takao Ohtsuka MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yoshinao Oda MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masafumi Nakamura MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masafumi Nakamura MD, PhD.

Ethics declarations

Disclosure

All authors declares that they have no conflicts of interest directly relevant to the content of this article.

Electronic supplementary material

Below is the link to the electronic supplementary material.

FIG. S1a.

Comparison of overall survival (OS) according to Prognostic Nutritional Index (PNI) for patients with surgical resection for pancreatic ductal adenocarcinoma. The median OS of patients with surgical resection was significantly shorter in patients with PNI < 45 than in those with PNI ≥ 45 (18.1 and 36.1 months, respectively; p < 0.001). FIG. S1b. Comparison of disease-free survival (DFS) according to Prognostic Nutritional Index (PNI) for patients with surgical resection for pancreatic ductal adenocarcinoma. The median DFS of patients with surgical resection was significantly shorter in patients with PNI < 45 than in those with PNI ≥ 45 (9 and 19 months, respectively; p < 0.001). DFS data were missing for eight patients in the PNI < 45 group and eight patients in the PNI ≥ 45 group. FIG. S1c. Comparison of overall survival (OS) based on neutrophil/lymphocyte ratio (NLR) in patients who underwent palliative surgery for pancreatic ductal adenocarcinoma. The median OS of patients who underwent palliative surgery was significantly longer in patients with NLR < 5 than in those with NLR ≥ 5 (2.7 and 8.9 months, respectively; p < 0.001). (PDF 41 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abe, T., Nakata, K., Kibe, S. et al. Prognostic Value of Preoperative Nutritional and Immunological Factors in Patients with Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol 25, 3996–4003 (2018). https://doi.org/10.1245/s10434-018-6761-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-018-6761-6

Keywords

Search

Navigation