Mohammad Hosein Aziz1, Kostandinos Sideras1, Nasir Ahmad Aziz2, Katya Mauff3, Roel Haen4, Daphne Roos4, Lawlaw Saida5, Mustafa Suker1, Erwin van der Harst6, Jan Sven Mieog7, Bert A Bonsing7, Yarne Klaver8, Bas Groot Koerkamp1, Casper H van Eijck1. 1. Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands. 2. Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands. 3. Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands. 4. Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands. 5. Department of Health Sciences, Vrije Universiteit, Amsterdam, the Netherlands. 6. Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands. 7. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. 8. Department of Medical Oncology, Laboratory of Tumor Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Abstract
OBJECTIVE: Our aim was to determine the prognostic significance of the systemic-immune-inflammation index (SIII) in patients with resectable pancreatic cancer, using cancer-specific survival as the primary outcome. BACKGROUND: Pancreatic cancer is associated with a dysfunctional immune system and poor prognosis. We examined the prognostic significance of the SIII in patients with resectable pancreatic ductal adenocarcinoma (PDAC) and the effects of bilirubin on this index. METHODS: We retrospectively assessed all pancreatic resections performed between 2004 and 2015 at 4 tertiary referral centers to identify pathologically confirmed PDAC patients. Baseline clinicopathologic characteristics, preoperative laboratory values such as absolute neutrophil, lymphocyte, and platelet counts, C-reactive protein, albumin, bilirubin, and CA19-9 levels, and also follow-up information, were collected. The associations of the calculated inflammatory indices with outcome were both internally and externally validated. RESULTS: In all, 590 patients with resectable PDAC were included. The discovery and validation cohort included 170 and 420 patients, respectively. SIII >900 [hazard ratio (HR) 2.32, 95% confidence interval (CI) 1.55-3.48], lymph node ratio (HR 3.75, 95% CI 2.08-6.76), and CA19.9 >200 kU/L (HR 1.62, 95% CI 1.07-2.46) were identified as independent predictors of cancer-specific survival. Separate model analysis confirmed that preoperative SIII contributed significantly to prognostication. However, SIII appeared to lose its prognostic significance in patients with bilirubin levels above 200 μmol/L. CONCLUSIONS: SIII is an independent predictor of cancer-specific survival and recurrence in patients with resectable PDAC. SIII may lose its prognostic significance in patients with high bilirubin levels. Properly designed prospective studies are needed to further confirm this hypothesis.
OBJECTIVE: Our aim was to determine the prognostic significance of the systemic-immune-inflammation index (SIII) in patients with resectable pancreatic cancer, using cancer-specific survival as the primary outcome. BACKGROUND:Pancreatic cancer is associated with a dysfunctional immune system and poor prognosis. We examined the prognostic significance of the SIII in patients with resectable pancreatic ductal adenocarcinoma (PDAC) and the effects of bilirubin on this index. METHODS: We retrospectively assessed all pancreatic resections performed between 2004 and 2015 at 4 tertiary referral centers to identify pathologically confirmed PDACpatients. Baseline clinicopathologic characteristics, preoperative laboratory values such as absolute neutrophil, lymphocyte, and platelet counts, C-reactive protein, albumin, bilirubin, and CA19-9 levels, and also follow-up information, were collected. The associations of the calculated inflammatory indices with outcome were both internally and externally validated. RESULTS: In all, 590 patients with resectable PDAC were included. The discovery and validation cohort included 170 and 420 patients, respectively. SIII >900 [hazard ratio (HR) 2.32, 95% confidence interval (CI) 1.55-3.48], lymph node ratio (HR 3.75, 95% CI 2.08-6.76), and CA19.9 >200 kU/L (HR 1.62, 95% CI 1.07-2.46) were identified as independent predictors of cancer-specific survival. Separate model analysis confirmed that preoperative SIII contributed significantly to prognostication. However, SIII appeared to lose its prognostic significance in patients with bilirubin levels above 200 μmol/L. CONCLUSIONS: SIII is an independent predictor of cancer-specific survival and recurrence in patients with resectable PDAC. SIII may lose its prognostic significance in patients with high bilirubin levels. Properly designed prospective studies are needed to further confirm this hypothesis.
Authors: Pranav Murthy; Mazen S Zenati; Amr I Al Abbas; Caroline J Rieser; Nathan Bahary; Michael T Lotze; Herbert J Zeh; Amer H Zureikat; Brian A Boone Journal: Ann Surg Oncol Date: 2019-12-02 Impact factor: 5.344
Authors: Herbert J Zeh; Nathan Bahary; Brian A Boone; Aatur D Singhi; Jennifer Lee Miller-Ocuin; Daniel P Normolle; Amer H Zureikat; Melissa E Hogg; David L Bartlett; Kenneth K Lee; Allan Tsung; J Wallis Marsh; Pranav Murthy; Daolin Tang; Natalie Seiser; Ravi K Amaravadi; Virginia Espina; Lance Liotta; Michael T Lotze Journal: Clin Cancer Res Date: 2020-03-10 Impact factor: 12.531