Based On The Inflammatory And Nutritional Indicators In Peripheral Blood To Establish A Survival Model For Patients With Pancreatic Cancer Chemotherapy And Analysis Of Prognostic Factors

Background: Pancreatic cancer is one of the most malignant and highly recurrent and metastatic digestive system malignancies,with a low early diagnosis rate and a high mortality rate,and a 5-year survival rate of less than 10%.Therefore,its clinical treatment effect is not ideal and the prognosis is poor.Radical resection is currently the only possible way to cure pancreatic cancer,but due to its high recurrence rate,adjuvant chemotherapy is essential to control recurrence and prolong survival.However,most patients are in the late stage of the tumor when they seek medical advice,and have lost the opportunity for surgery.In order to inhibit tumor progression,the comprehensive therapy of chemotherapy based on radiotherapy,targeted therapy and immunotherapy is becoming more and more mature.However,due to the high heterogeneity of pancreatic cancer,the chemotherapy effect of different individuals varies greatly.In addition,chemotherapy causes fibrosis around pancreatic tissue,and conventional imaging examination cannot accurately judge its efficacy.Therefore,there is currently a lack of effective evaluation methods for the prognosis and efficacy of chemotherapy for pancreatic cancer patients.Tumor-related inflammatory response has been proven to interact chronically with tumor growth.The nutritional status of the body is also an important factor affecting tumor progression.Studies have found that the neutrophil lymphocyte ratio(NLR)composed of the absolute value of neutrophils and the absolute value of lymphocytes,as well as the prognostic nutritional index(PNI)calculated based on serum albumin and lymphocytes,can not only be used as indicators of tumor-related inflammation and nutritional status,but also can be used for prognostic evaluation of various malignant tumors.However,there are few related studies on the application of NLR and PNI in pancreatic cancer.Objective: The purpose of this study is to construct a prognosis and survival model for patients with pancreatic cancer chemotherapy based on inflammatory and nutritional indicators in peripheral blood,and to explore the factors that affect the prognosis of patients during chemotherapy.Method:Case collection: Retrospective collection of chemotherapy patients who were pathologically diagnosed with pancreatic cancer in the First Affiliated Hospital of Dalian medical university from January 2017 to January 2022.Finally,134 patients who had completed more than 3 cycles of chemotherapy,did not change their chemotherapy regimen,and had complete clinical information and follow-up data were included.Survival model construction: collect the inflammatory index NLR and nutritional index PNI in the peripheral blood of chemotherapy patients,and calculate the Area Under Curve(AUC)and Youden index through the Receiver Operating Characteristic(ROC)curve(Youden index = sensitivity + specificity-1)to obtain the best cut-off value(cut-off value)to construct the survival model.Predictive efficacy test of survival model: Chi-square test or Fisher’s exact test was used to analyze the relationship between survival model and clinical pathological features,and log-rank test was used for survival analysis.Analysis of prognostic factors: COX proportional hazards regression model was used for univariate and multivariate analysis of prognosis,and the hazard ratio(Hazard Ratio,HR)and 95%CI were calculated at the same time.Result:1.A total of 134 patients were included in this study,and the overall median survival time was 12 months.There are differences in the changes(Carbohydrate antigen199,CA199).(p<0.05)There was no significant statistical difference among groups such as gender,age,history of diabetes,history of hypertension,history of drinking,history of chronic pancreatitis(p>0.05).2.The cut-off values of NLR and PNI are 2.92 and 41.25,respectively.Low NLR group(<2.92)and high PNI group(≧41.25)had significantly longer OS than high NLR group(≧2.92)and low PNI group(<41.25),and the difference was statistically significant.(P<0.05)3.Based on the cut-off values of NLR and PNI,patients with different survival model scores obtained by constructing survival models had statistically significant differences in tumor location,tumor stage,surgical resection,bone marrow suppression,and CA199 changes(P<0.05).Survival analysis showed that the higher the survival model score,the shorter the OS and the worse the prognosis(P<0.001)4.The results of univariate analysis showed that tumor stage Ⅲ+Ⅲ,tumor located in the body and tail,no surgical resection,no myelosuppression,previous smoking history,no decline in CA199,and high survival model score were the risk factors affecting the prognosis of patients with pancreatic cancer chemotherapy.(P<0.05)Multivariate analysis showed that no surgical resection,no myelosuppression,previous smoking history,no decline in CA199,and high survival model scores were independent risk factors affecting the prognosis of pancreatic cancer patients undergoing chemotherapy.(P<0.05)Conclusion:The prognosis of patients with pancreatic cancer chemotherapy is affected by many factors,and the overall prognosis is poor.Among them,no surgical resection,no myelosuppression,smoking history,no decline in CA199,and high survival model scores are independent risk factors affecting the prognosis of patients with pancreatic cancer chemotherapy.The cut-off values of NLR and PNI are 2.92 and 41.25,respectively.The survival model constructed based on peripheral blood NLR and PNI can be used to predict the prognosis of pancreatic cancer patients undergoing chemotherapy.