Inflammation-based score such as Glasgow prognostic score (GPS) or Neutrophil -Lymphocyte ratio (NLR) is associated with clinical outcome of cancer patients. However, the prognostic value of GPS and NLR for patients with advanced pancreatic cancer who received systemic chemotherapy remains unclear.
We conducted single center retrospective study. Inclusion criteria was defined as patients with metastatic or recurrent pancreatic cancer treated with FFX or GnP as first line treatment at Hokkaido university hospital between January 2014 and December 2018. Baseline GPS was identified that GPS 0 was CRP ≤1.0 mg/dL and Alb ≥3.5 g/dL, GPS 1 was CRP >1.0 mg/dL or Alb <3.5 g/dL, and GPS 2 was CRP >1.0 mg/dL and Alb <3.5 g/dL. NLR was defined as the ratio of absolute neutrophil count and absolute lymphocyte count. As no clear NLR cutoff level has been established in this setting, we used the cutoff ≧3. Cox-proportional hazards model were used to identify prognostic factors in univariate and multivariate analyses.
A total of 101 patients were eligible. Median age of patients was 67, male/female was 63/38, ECOG PS 0/1/2 was 36/62/3, FFX/GnP was 19/82, GPS 0/1/2/unknown was 52/21/23/5, NLR ≧3/<3/unknown was 51/44/6, respectively. In GPS 0/1-2 patients, median PFS were 5.2/2.3months (HR 1.772, 95%CI 1.165-2.693, p=0.007), median OS were 12.4/5.7 months (HR 2.384, 95%CI 1.534-3.706, p<0.001), respectively. In NLR 3</≧3 patients, median PFS were 6.4/2.6 months (HR 2.436, 95%C.I. 1.568-3.784, p<0.001), median OS were 14.6/6.0 months (HR 2.496, 95% C.I. 1.616-3.856, p<0.001), respectively. In multivariate analysis, High NLR (NLR ≧3 vs <3 : HR 2.067, 95%C.I. 1.278-3.343, p=0.003) was significantly associated with poor PFS. For OS, female (HR 2.006, 95%C.I. 1.206-3.34, p=0.007), liver metastasis (HR 2.137, 95%C.I. 1.281-3.565, p=0.004), high NLR (NLR ≧3 vs <3: HR 2.745, 95%C.I. 1.639-4.599, p<0.001), high GPS (GPS 0 vs 1-2: HR 2.016, 95%C.I. 1.233-3.296, p<0.001) were significantly associated with poor OS.
NLR may be better prognosticator than GPS for patients with metastatic or recurrent pancreatic cancer treated with FFX or GnP.
The authors.
Has not received any funding.
H. Nakatsumi: Honoraria (self): Takeda; Honoraria (self): Sanofi; Honoraria (self): Merck Biopharma; Honoraria (self): Taiho Pharmaceutical; Honoraria (self): Ono Pharmaceutical. Y. Kawamoto: Honoraria (self): Taiho Pharmaceutical; Honoraria (self): Takeda; Honoraria (self): Chudai Pharma; Honoraria (self): Daiichi Sankyo; Honoraria (self): Merck; Honoraria (self): Lilly; Honoraria (self): Japan Agency for Medical Research and Development. S. Yuki: Honoraria (self): Takeda Pharmaceutical Co., Ltd.; Honoraria (self): Ono Pharmaceutical Co., Ltd.; Honoraria (self): Sanofi K.K.; Honoraria (self): Bayer Yakuin., Ltd.; Honoraria (self): Eli Lilly K.K.; Honoraria (self): Bristol-Myers Squibb Co., Ltd.; Honoraria (self): Merck Biopharma Co., Ltd.; Honoraria (self): Chudai Pharmaceutical Co., Ltd.; Honoraria (self): Taiho Pharmaceutical Co., Ltd.; Honoraria (self): Yakult Honsha Co., Ltd.; Honoraria (self): MSD K.K. N. Sakamoto: Honoraria (self): Gilead Sciences; Honoraria (self): Chudai Pharm; Honoraria (self): Bayer AG; Honoraria (self): Otsuka Pharm; Honoraria (self): Daiichi-Sankyo; Honoraria (self): Astellas Pharma; Honoraria (self): Takeda; Honoraria (self): Eisai; Research grant/Funding (self): Gilead Sciences; Research grant/Funding (self): Eisai; Research grant/Funding (self): MSD; Research grant/Funding (self): Otsuka Pharm; Research grant/Funding (self): AbbVie; Research grant/Funding (self): Asuka Pharm. Y. Komatsu: Research grant/Funding (institution): Eisai; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (institution): Daiichi-Sankyo; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (institution): Yakult; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (institution): Chugai; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (institution): Taiho; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (institution): Lilly; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (institution): Sanofi; Research grant/Funding (institution): MSD; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (institution): Ono; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (institution): Nipro; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (institution): Asahikasei; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (institution): Nihonkayaku; Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (institution): Takeda; Honoraria (self), Research grant/Funding (self): Bayer; Honoraria (self): Kyowa Kirin; Honoraria (self): Merck Biopharma; Honoraria (self): Bristol-Myers Squibb; Honoraria (self): Shire Japan; Honoraria (self): Novartis Pharma; Honoraria (self): Pfizer. All other authors have declared no conflicts of interest.