CONTEXT: There is paucity of data on the prognostic value of pre-operative inflammatory response and post-operative lymph node ratio on patient survival after pancreatic-head resection for pancreatic ductal adenocarcinoma. OBJECTIVES: To evaluate the role of the preoperative inflammatory response and postoperative pathology criteria to identify predictive and/or prognostic variables for pancreatic ductal adenocarcinoma. DESIGN: All patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma between 2002 and 2008 were reviewed retrospectively. The following impacts on patient survival were assessed: i) preoperative serum CRP levels, white cell count, neutrophil count, neutrophil/lymphocyte ratio, lymphocyte count, platelet/lymphocyte ratio; and ii) post-operative pathology criteria including lymph node status and lymph node ratio. RESULTS: Fifty-one patients underwent potentially curative resection for pancreatic ductal adenocarcinoma during the study period. An elevated preoperative CRP level (greater than 3 mg/L) was found to be a significant adverse prognostic factor (P=0.015) predicting a poor survival, whereas white cell count (P=0.278), neutrophil count (P=0.850), neutrophil/lymphocyte ratio (P=0.272), platelet/lymphocyte ratio (P=0.532) and lymphocyte count (P=0.721) were not significant prognosticators at univariate analysis. Presence of metastatic lymph nodes did not adversely affect survival (P=0.050), however a raised lymph node ratio predicted poor survival at univariate analysis (P<0.001). The preoperative serum CRP level retained significance at multivariate analysis (P=0.011), together with lymph node ratio (P<0.001) and tumour size (greater than 2 cm; P=0.008). CONCLUSION: A pre-operative elevated serum CRP level and raised post-operative lymph node ratio represent significant independent prognostic factors that predict poor prognosis in patients undergoing curative resection for pancreatic ductal adenocarcinoma. There is potential for future neo-adjuvant and adjuvant treatment strategies in pancreatic cancer to be tailored based on preoperative and postoperative factors that predict a poor survival.
CONTEXT: There is paucity of data on the prognostic value of pre-operative inflammatory response and post-operative lymph node ratio on patient survival after pancreatic-head resection for pancreatic ductal adenocarcinoma. OBJECTIVES: To evaluate the role of the preoperative inflammatory response and postoperative pathology criteria to identify predictive and/or prognostic variables for pancreatic ductal adenocarcinoma. DESIGN: All patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma between 2002 and 2008 were reviewed retrospectively. The following impacts on patient survival were assessed: i) preoperative serum CRP levels, white cell count, neutrophil count, neutrophil/lymphocyte ratio, lymphocyte count, platelet/lymphocyte ratio; and ii) post-operative pathology criteria including lymph node status and lymph node ratio. RESULTS: Fifty-one patients underwent potentially curative resection for pancreatic ductal adenocarcinoma during the study period. An elevated preoperative CRP level (greater than 3 mg/L) was found to be a significant adverse prognostic factor (P=0.015) predicting a poor survival, whereas white cell count (P=0.278), neutrophil count (P=0.850), neutrophil/lymphocyte ratio (P=0.272), platelet/lymphocyte ratio (P=0.532) and lymphocyte count (P=0.721) were not significant prognosticators at univariate analysis. Presence of metastatic lymph nodes did not adversely affect survival (P=0.050), however a raised lymph node ratio predicted poor survival at univariate analysis (P<0.001). The preoperative serum CRP level retained significance at multivariate analysis (P=0.011), together with lymph node ratio (P<0.001) and tumour size (greater than 2 cm; P=0.008). CONCLUSION: A pre-operative elevated serum CRP level and raised post-operative lymph node ratio represent significant independent prognostic factors that predict poor prognosis in patients undergoing curative resection for pancreatic ductal adenocarcinoma. There is potential for future neo-adjuvant and adjuvant treatment strategies in pancreatic cancer to be tailored based on preoperative and postoperative factors that predict a poor survival.
Authors: Shahid G Farid; Gavin A Falk; Daniel Joyce; Sricharan Chalikonda; R Matthew Walsh; Andrew M Smith; Gareth Morris-Stiff Journal: HPB (Oxford) Date: 2012-11-19 Impact factor: 3.647
Authors: Lewis Stevens; Samir Pathak; Quentin M Nunes; Sanjay Pandanaboyana; Christian Macutkiewicz; Neil Smart; Andrew M Smith Journal: HPB (Oxford) Date: 2014-11-27 Impact factor: 3.647
Authors: Chen Yuan; Vicente Morales-Oyarvide; Natalia Khalaf; Kimberly Perez; Fred K Tabung; Gloria Y F Ho; Charles Kooperberg; Aladdin H Shadyab; Lihong Qi; Peter Kraft; Howard D Sesso; Edward L Giovannucci; JoAnn E Manson; Meir J Stampfer; Kimmie Ng; Charles S Fuchs; Brian M Wolpin; Ana Babic Journal: J Natl Cancer Inst Date: 2021-09-04 Impact factor: 13.506
Authors: M Stotz; A Gerger; F Eisner; J Szkandera; H Loibner; A L Ress; P Kornprat; W AlZoughbi; W A Zoughbi; F S Seggewies; C Lackner; T Stojakovic; H Samonigg; G Hoefler; M Pichler Journal: Br J Cancer Date: 2013-06-25 Impact factor: 9.075
Authors: J Szkandera; M Stotz; G Absenger; T Stojakovic; H Samonigg; P Kornprat; R Schaberl-Moser; W Alzoughbi; C Lackner; A L Ress; F S Seggewies; A Gerger; G Hoefler; M Pichler Journal: Br J Cancer Date: 2013-11-07 Impact factor: 9.075