Relationship Between Inflammation Score And Prognosis Of Patients With Advanced Pancreatic Cancer

Background and ObjectiveAccording to the latest report of the global cancer burden in 2020,the incidence and mortality of pancreatic cancer were increasing year by year in the world,and its incidence and mortality ranked 12 th and 7th respectively.The incidence of pancreatic cancer in China ranked eighth in malignant tumors and sixth in cancer-related deaths,and the number of new cancers and cancer deaths in China ranked first in the world.Pancreatic cancer is mostly found in advanced stage,and the therapeutic effect is not satisfactory.Although the prognosis has improved slightly in recent years,the 5-year survival rate was still less than 8%.Therefore,in order to improve the survival time and prognosis of patients with pancreatic cancer,early diagnosis and intervention of prognostic factors are of great significance.There are many prognostic indicators of human malignant tumors,but most of the tests are expensive or cannot be obtained before treatment.therefore,the search for new,cheap and easily available prognostic indicators may help to reduce this human burden.Inflammation is considered to be one of the markers of cancer.Inflammation-driven tumorigenesis and tumor progression play a key role in malignant tumors.There is a strong correlation between local and systemic inflammatory response and tumor occurrence,development,metastasis and prognosis.In clinic,this systemic inflammatory response can be reacted by some inflammatory factors,cytokines and inflammatory cells,and tumor-related inflammatory markers may be used as prognostic factors.This study was used to determine whether the relevant inflammation score could be used as a predictor of survival and prognosis in patients with advanced pancreatic cancer.MethodsBased on a retrospective analysis of the electronic medical record database of the second affiliated Hospital of Zhengzhou University from January 2015 to June 2018,87 patients who were diagnosed as advanced pancreatic ductal adenocarcinoma by histology or cytology and did not receive any anti-tumor therapy and anti-inflammatory drugs were selected.The information collected includes sex,age,tumor location,TNM stage,serum albumin level,neutrophil count,lymphocyte count,platelet count,personal history(smoking,drinking history),past history(diabetes,pancreatitis history),tumor markers(CEA,CA199,CA125).According to the clinical information,the relevant inflammation scores were calculated: neutrophil /lymphocyte ratio(NLR),platelet / lymphocyte ratio(PLR),prognostic nutrition index(PNI): serum albumin + 5×peripheral blood lymphocyte count,systemic immune inflammation index(SII): platelet×neutrophil / lymphocyte,and clinical follow-up,the main end point of the study was overall survival.The statistical software SPSS26.0 was used,and the measurement data were expressed by x±s.Independent sample t-test and one-way analysis of variance(One-way ANOVA)were used to compare the mean of two samples and multiple samples.The survival rates were analyzed and compared by Kaplan-Meier method and Log-rank test.The relationship between influencing factors and prognostic survival time was analyzed by univariate and multivariate COX proportional hazard regression model,and the difference was statistically significant(P<0.05).Results1.The average survival time of 87 patients with advanced pancreatic cancer was8.87±3.57 months,the median survival time was 8.00 months,the 6-month survival rate was 80.46%,and the 1-year survival rate was 10.34%.2.Comparison of survival time among groups: there was no significant difference in survival time based on sex,age,personal history,past history and tumor marker CEA,but there was significant difference in survival time among groups based on inflammation score(NLR,PLR,PNI,SII),tumor markers(CA199,CA125),TNM stage,tumor location and other clinical basic characteristics.The survival time of patients with NLR≥156.88 was shorter than that of patients with NLR<5.15,the survival time of patients with PLR≥156.88 was shorter than that of patients with PLR<156.88,the survival time of patients with PNI<46.3 was shorter than that of patients with PNI ≥46.3,the survival time of patients with SII≥989.86 was shorter than that of patients with SII<989.86,the survival time of patients with high levels of CA199 and CA125 was shorter,the survival time of clinical TNM stage IV was shorter than that of stage III,and the location of tumor.The survival time of pancreatic head cancer was higher than that of pancreatic body and tail cancer and that of whole pancreatic cancer.3.Comparison of survival rate among groups: there was no significant difference in survival rate among different groups based on sex,age,personal history,past history,tumor marker CEA and other clinical basic characteristics(P>0.05).The survival rate of patients with NLR≥5.15 was lower than that of patients with NLR<5.15.The survival rate of patients with PLR≥156.88 was lower than that of patients with PLR<156.88.The survival rate of patients with PNI<46.3 was lower than that of patients with PNI≥46.3,the survival rate of patients with SII≥989.86 was lower than that of patients with SII<989.86,the survival rate of patients with CA199≥544U/ml was lower than that of patients with CA199<544U/ml,and the survival rate of patients with CA125≥26.7U/ml was lower than that of patients with CA125<26.7U/ml.The survival rate of patients with TNM stage IV stage was lower than that of patients with TNM stage III stage.The Log-rank test results of the above clinical basic features showed that there was significant difference in the survival rate of patients with advanced pancreatic cancer.It was suggested that the lower the level of Results inflammation score(NLR,PLR,SII)and tumor markers(CA199,CA125),the higher the PNI level of inflammation score and the earlier the stage,the higher the survival rate of patients with advanced pancreatic cancer.4.COX univariate analysis showed that inflammation score(NLR,PLR,PNI,SII),tumor markers(CA199,CA125),TNM stage,tumor location and other factors(P<0.05),indicating that inflammation score(NLR,PLR,PNI,SII),tumor markers(CA199,CA125),TNM stage,tumor location were related to the poor prognosis of patients with advanced pancreatic cancer,and the above factors were substituted into COX multivariate analysis.The results showed that PLR,PNI,CA125,TNM stage,tumor location and other factors were P<0.05,among which inflammation score PLR and PNI were potential independent risk factors affecting the prognosis of advanced pancreatic cancer.ConclusionsInflammation score NLR,PLR,PNI and SII have influence on the prognosis of advanced pancreatic cancer.Tumor markers(CA199,CA125),TNM stage and tumor location are related to the poor prognosis of patients with advanced pancreatic cancer.Inflammation score PLR and PNI are potential independent risk factors that may affect the prognosis of advanced pancreatic cancer.