Clinical Significance And Prognostic Analysis Of Tumor-infiltrating T Lymphocytes And Ki-67 Index In Pancreatic Ductal Adenocarcinoma

Objectives:In recent years,although we have made much progress in the treatment of PD AC in terms of surgical treatment,chemotherapy,and targeted therapy,the prognosis of PDAC patients is still unsatisfactory.At present,many related studies have been focusing on the PDAC tumor microenvironment.This article aims to study the clinical significance and prognostic analysis of tumor-infiltrating T lymphocytes and Ki-67 index in the PDAC tumor microenvironment,so as to provide some references and basis for further research on PDAC.Methods:This study includes 75 patients who underwent radical resection of PDAC in the Second Affiliated Hospital of Kunming Medical University from June 2015 to December 2019.The clinical data came from the patient’s medical records and postoperative follow-up,including gender,age,preoperative laboratory indicators,preoperative imaging examinations,postoperative laboratory examinations and postoperative imaging examinations,pathological examinations,surgical methods and survival time,etc.According to the 8th edition of AJCC pancreatic cancer TNM staging system,pathological specimens are staged.OS is defined as the time from surgery to death from any cause.This study is approved by the Ethical Review Committee of the Second Affiliated Hospital of Kunming Medical University and is conducted in accordance with the Declaration of Helsinki.This study collected the general condition of the patient within two weeks before surgery,preoperative laboratory examination indicators and postoperative pathological results,including the patient’s gender,age,NLR,preoperative CEA,preoperative CA19-9,tumor location,degree of differentiation,ACJJ tumor staging,and so on,and performe univariate analysis and multivariate analysis on them to evaluate the prognostic effect of these indicators on PD AC patients.The tumor-infiltrating T lymphocytes and Ki-67 index in the PDAC tumor microenvironment are closely related to the patient’s prognosis.We used immunohistochemical methods to study the tumor-infiltrating T cells and Ki-67 index in the PDAC tumor microenvironment,and univariate analysis and multivariate correlation analysis of tumor infiltrating T cells and Ki-67 fingering are performed to explore their relationship with OS in PDAC patients.In this study,the patient’s OS and time of death were obtained and confirmed through medical records and telephone follow-up.Kaplan-Meier analysis is used to draw the overall survival rate survival curve,and the 1-year,2-year and 3-year survival rates are calculated according to the survival analysis table;the log-rank test is used to compare survival rates between different groups.The Cox proportional hazards regression model is used to compare the immunohistochemical staining of Ki-67,CD4 and CD8,preoperative laboratory data and imaging data,etc.,to analyze the factors affecting the prognosis of PDAC patients.Results:A total of 75 postoperative PDAC patients are enrolled in this study,with an average age of 57.61±9.92 years old,of which the youngest is 32 years old and the oldest is 79 years old;44(58.7%)males and 31(41.3%)females,with a male-to-female ratio of 1.42:1.The median survival time is 413 days.According to the ROC curve,the best cut-off values of NLR,CD4/CD8 and Ki-67 index are determined and grouped.The influencing factors(gender,age,surgical method,tumor location,ACJJ tumor staging,preoperative CEA,preoperative CA199,degree of differentiation,NLR,CD4/CD8 and Ki-67 index)of patients undergoing PDAC are analyzed by univariate analysis.It is concluded that the degree of differentiation(P=0.005),NLR(P=0.004),CD4/CD8(P=0.001),Ki-67 index(P=0.032)can be used as risk factors for OS among postoperative PDAC patients.The degree of differentiation,NLR,CD4/CD8,and Ki-67 index are analyzed by multivariate analysis.The results show that the degree of differentiation(P=0.040),NLR(P=0.026),CD4/CD8(P=0.034)are independent risk factors affecting the postoperative PDAC patient’s OS.Conclusions:1.This study shows that the degree of differentiation,NLR,CD4/CD8 and Ki-67 index are significantly correlated with the OS of postoperative PDAC patients.2.The degree of differentiation,NLR,and CD4/CD8 are independent risk factors that affect OS among postoperative PDAC patients.Ki-67 index is a risk factor that affects OS among postoperative PDAC patients.If the patient has a low degree of tumor differentiation,NLR>cut-off value(2.24),CD4/CD8 ratio is larger,Ki-67 index>cut-off value(32.5%),the patient’s prognosis is worse,their doctors may consider giving them more active treatments,reviews and follow-up to improve the prognosis of high-risk patients.3.The Ki-67 index is a commonly used index for the pathologicalclassification of PDAC.With the advancement of research technology and the deepening of the research of PDAC tumor microenvironment,it show us great value and potential in many aspects.