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Markers of tumour inflammation are prognostic for overall survival in patients with advanced pancreatic ductal adenocarcinoma receiving FOLFIRINOX chemotherapy
Appleyard, J. Kamposioras, Konstantinos Papaxoinis, G. Collinson, F. Ahmad, U. Wright, F. Damyanova, I. Razzaq, M. Anthoney, A.
Appleyard, J.
Kamposioras, Konstantinos
Papaxoinis, G.
Collinson, F.
Ahmad, U.
Wright, F.
Damyanova, I.
Razzaq, M.
Anthoney, A.
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Abstract
Background: Pancreatic duct adenocarcinoma (PDAC) remains a devastating disease with little improvement in survival figures over the last decades. Better characterization and identification of high risk groups are needed to tailor their management. Herein we explore the prognostic role of different clinical biomarkers in patients with PDAC treated with FOLFIRINOX. Methods: We retrospectively audited patients with locally advanced inoperable or metastatic PDAC that received FOLFIRINOX as first-line treatment in West Yorkshire, UK, between 09/2010 and 09/2019. Different prognostic clinical biomarkers were evaluated in multivariate models. Results: The study included 138 pts with advanced pancreatic adenocarcinoma. 87 (63%) were males and 51 (37%) females. Median age was 62 years (range, 29-77). 66 (47.8%) had excellent performance status (PS ECOG 0), 71 (51.4%) PS 1 and one pt (0.8%) had PS ECOG 2. Charlson comorbidity index (CCI) was 0 in 66 (47.8%) of pts, 1 in 25 (18.1%), 2 in 16 (11.6%) and 3 in 31 (22.5%) pts. 78 (56.5%) had metastatic and 60 (43.5%) locally advanced disease. Median blood hemoglobin levels were 128 g/L (range, 81-171), median white blood cell (WBC) levels 8.17/uL (3.42-33.50), neutrophil (NEUT) levels 5.68/nL (range, 1.98-22.13), lymphocyte (LYMPH) 1.58/nL (range, 0.314.90), monocyte (MONO) 0.51/nL (range, 0.16-1.86), platelet (PLT) 271/nL (range, 90631) and median serum albumin (ALB) levels 39 g/L (range, 24-51). Median neutrophiltolymphocyte ratio (NLR) was 3.58 (range, 1.13-25.29), monocyte-to-lymphocyte ratio (MLR) 0.36 (range, 0.10-1.10), platelet-to-lymphocyte ratio (PLR) 176.46 (range, 42.40678-48), prognostic nutritional index (PNI¼ALB+[5 LYMPH]) was 47.08 (range, 28.9566.55) and systemic inflammation response index (SIRI¼NEUT MONO/LYMPH) was 1.89 (range, 0.31-21.75). After a median follow-up of 42.7 months (range, 0.3-64.9), 128 (92.8%) patients died. Median overall survival (OS) was 9.7 months (95%CI, 8.011.3). NLR (HR 1.08, 95%CI 1.04-1.11, p<0.001), MLR (HR 7.57, 95%CI 3.05-18.83, p<0.001), PLR (HR 1.004, 95%CI 1.002-1.006, p<0.001), SIRI (HR 1.12, 95%CI 1.07-1.17, p<0.001) and PNI (HR 0.97, 95%CI 0.94-0.99, p¼0.011), all were associated with OS. Cox proportional hazard models separately for each of the above variables showed that NLR, MLR, PLR and SIRI were associated with poor OS independently of age, sex, PS ECOG, CCI and stage (metastatic vs. locally advanced). Also, stage constantly demonstrated an independent prognostic significance for OS in all analyses. In contrast, PNI did not demonstrate independent prognostic significance. Conclusion: Clinical biomarkers are useful to identify high risk patients with pancreatic cancer treated with Folfirinox. Stratification of this group of patients based on the biomarkers should be considered in the design of future trials.
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Date
2020
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Meetings and Proceedings
Citation
Appleyard J, Kamposioras K, Papaxoinis G, Collinson F, Ahmad U, Wright F, et al. P-126 Markers of tumour inflammation are prognostic for overall survival in patients with advanced pancreatic ductal adenocarcinoma receiving FOLFIRINOX chemotherapy. Annals of Oncology. 2020;31:S131.