Cargando…

C-Reactive Protein and Neutrophil/Lymphocytes Ratio: Prognostic Indicator for Doubling Overall Survival Prediction in Pancreatic Cancer Patients

Background: Despite modern chemotherapy regimens, survival of patients with locally advanced/metastatic pancreatic cancer remains dismal. Long-term survivors are rare and there are no prognostic scores to identify patients benefitting most from chemotherapy. Methods: This retrospective study include...

Descripción completa

Detalles Bibliográficos
Autores principales: Schlick, Konstantin, Magnes, Teresa, Huemer, Florian, Ratzinger, Lukas, Weiss, Lukas, Pichler, Martin, Melchardt, Thomas, Greil, Richard, Egle, Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912559/
https://www.ncbi.nlm.nih.gov/pubmed/31717722
http://dx.doi.org/10.3390/jcm8111791
_version_ 1783479485320921088
author Schlick, Konstantin
Magnes, Teresa
Huemer, Florian
Ratzinger, Lukas
Weiss, Lukas
Pichler, Martin
Melchardt, Thomas
Greil, Richard
Egle, Alexander
author_facet Schlick, Konstantin
Magnes, Teresa
Huemer, Florian
Ratzinger, Lukas
Weiss, Lukas
Pichler, Martin
Melchardt, Thomas
Greil, Richard
Egle, Alexander
author_sort Schlick, Konstantin
collection PubMed
description Background: Despite modern chemotherapy regimens, survival of patients with locally advanced/metastatic pancreatic cancer remains dismal. Long-term survivors are rare and there are no prognostic scores to identify patients benefitting most from chemotherapy. Methods: This retrospective study includes 240 patients with pancreatic cancer who were treated in a primary palliative setting between the years 2007 to 2016 in a single academic institution. Survival rates were analyzed using the Kaplan–Meier method. Prognostic models including laboratory and clinical parameters were calculated using Cox proportional models in univariate and multivariate analyses. Results: Median age at diagnosis was 67 years (range 29–90 years), 52% were female and a majority had an ECOG performance status of 0 or 1. Locally advanced pancreatic cancer was diagnosed in 23.3% (n = 56) and primary metastatic disease in 76.7% (n = 184) of all patients. Median overall survival of the whole study cohort was 8.3 months. Investigating potential risk factors like patient characteristics, tumor marker or inflammatory markers, multivariate survival analysis found CRP (c-reactive protein) and NLR (neutrophil to lymphocyte ratio) elevation before the start of palliative chemotherapy to be independent negative prognostic factors for OS (overall survival) (p < 0.001 and p < 0.01). Grouping patients with no risk factor versus patients with one or two of the above mentioned two risk factors, we found a median OS of 16.8 months and 9.4 months (p < 0.001) respectively. By combining these two factors, we were also able to identify pancreatic cancer patients that were more likely to receive any post first line therapy. These two risk factors are predictive for improved survival independent of disease stage (III or IV) and applied chemotherapy agents in first line. Conclusion: By combining these two factors, CRP and NLR, to create a score for OS, we propose a simple, new prognostic tool for OS prediction in pancreatic cancer.
format Online
Article
Text
id pubmed-6912559
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-69125592020-01-02 C-Reactive Protein and Neutrophil/Lymphocytes Ratio: Prognostic Indicator for Doubling Overall Survival Prediction in Pancreatic Cancer Patients Schlick, Konstantin Magnes, Teresa Huemer, Florian Ratzinger, Lukas Weiss, Lukas Pichler, Martin Melchardt, Thomas Greil, Richard Egle, Alexander J Clin Med Article Background: Despite modern chemotherapy regimens, survival of patients with locally advanced/metastatic pancreatic cancer remains dismal. Long-term survivors are rare and there are no prognostic scores to identify patients benefitting most from chemotherapy. Methods: This retrospective study includes 240 patients with pancreatic cancer who were treated in a primary palliative setting between the years 2007 to 2016 in a single academic institution. Survival rates were analyzed using the Kaplan–Meier method. Prognostic models including laboratory and clinical parameters were calculated using Cox proportional models in univariate and multivariate analyses. Results: Median age at diagnosis was 67 years (range 29–90 years), 52% were female and a majority had an ECOG performance status of 0 or 1. Locally advanced pancreatic cancer was diagnosed in 23.3% (n = 56) and primary metastatic disease in 76.7% (n = 184) of all patients. Median overall survival of the whole study cohort was 8.3 months. Investigating potential risk factors like patient characteristics, tumor marker or inflammatory markers, multivariate survival analysis found CRP (c-reactive protein) and NLR (neutrophil to lymphocyte ratio) elevation before the start of palliative chemotherapy to be independent negative prognostic factors for OS (overall survival) (p < 0.001 and p < 0.01). Grouping patients with no risk factor versus patients with one or two of the above mentioned two risk factors, we found a median OS of 16.8 months and 9.4 months (p < 0.001) respectively. By combining these two factors, we were also able to identify pancreatic cancer patients that were more likely to receive any post first line therapy. These two risk factors are predictive for improved survival independent of disease stage (III or IV) and applied chemotherapy agents in first line. Conclusion: By combining these two factors, CRP and NLR, to create a score for OS, we propose a simple, new prognostic tool for OS prediction in pancreatic cancer. MDPI 2019-10-25 /pmc/articles/PMC6912559/ /pubmed/31717722 http://dx.doi.org/10.3390/jcm8111791 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Schlick, Konstantin
Magnes, Teresa
Huemer, Florian
Ratzinger, Lukas
Weiss, Lukas
Pichler, Martin
Melchardt, Thomas
Greil, Richard
Egle, Alexander
C-Reactive Protein and Neutrophil/Lymphocytes Ratio: Prognostic Indicator for Doubling Overall Survival Prediction in Pancreatic Cancer Patients
title C-Reactive Protein and Neutrophil/Lymphocytes Ratio: Prognostic Indicator for Doubling Overall Survival Prediction in Pancreatic Cancer Patients
title_full C-Reactive Protein and Neutrophil/Lymphocytes Ratio: Prognostic Indicator for Doubling Overall Survival Prediction in Pancreatic Cancer Patients
title_fullStr C-Reactive Protein and Neutrophil/Lymphocytes Ratio: Prognostic Indicator for Doubling Overall Survival Prediction in Pancreatic Cancer Patients
title_full_unstemmed C-Reactive Protein and Neutrophil/Lymphocytes Ratio: Prognostic Indicator for Doubling Overall Survival Prediction in Pancreatic Cancer Patients
title_short C-Reactive Protein and Neutrophil/Lymphocytes Ratio: Prognostic Indicator for Doubling Overall Survival Prediction in Pancreatic Cancer Patients
title_sort c-reactive protein and neutrophil/lymphocytes ratio: prognostic indicator for doubling overall survival prediction in pancreatic cancer patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912559/
https://www.ncbi.nlm.nih.gov/pubmed/31717722
http://dx.doi.org/10.3390/jcm8111791
work_keys_str_mv AT schlickkonstantin creactiveproteinandneutrophillymphocytesratioprognosticindicatorfordoublingoverallsurvivalpredictioninpancreaticcancerpatients
AT magnesteresa creactiveproteinandneutrophillymphocytesratioprognosticindicatorfordoublingoverallsurvivalpredictioninpancreaticcancerpatients
AT huemerflorian creactiveproteinandneutrophillymphocytesratioprognosticindicatorfordoublingoverallsurvivalpredictioninpancreaticcancerpatients
AT ratzingerlukas creactiveproteinandneutrophillymphocytesratioprognosticindicatorfordoublingoverallsurvivalpredictioninpancreaticcancerpatients
AT weisslukas creactiveproteinandneutrophillymphocytesratioprognosticindicatorfordoublingoverallsurvivalpredictioninpancreaticcancerpatients
AT pichlermartin creactiveproteinandneutrophillymphocytesratioprognosticindicatorfordoublingoverallsurvivalpredictioninpancreaticcancerpatients
AT melchardtthomas creactiveproteinandneutrophillymphocytesratioprognosticindicatorfordoublingoverallsurvivalpredictioninpancreaticcancerpatients
AT greilrichard creactiveproteinandneutrophillymphocytesratioprognosticindicatorfordoublingoverallsurvivalpredictioninpancreaticcancerpatients
AT eglealexander creactiveproteinandneutrophillymphocytesratioprognosticindicatorfordoublingoverallsurvivalpredictioninpancreaticcancerpatients