scholarly journals Changes and prognostic impact of inflammatory nutritional factors during neoadjuvant chemoradiotherapy for patients with resectable and borderline resectable pancreatic cancer

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Minoru Oshima ◽  
Keiichi Okano ◽  
Hironobu Suto ◽  
Yasuhisa Ando ◽  
Hideki Kamada ◽  
...  
Keyword(s):  
External Beam Radiotherapy ◽  
Prognostic Score ◽  
Neoadjuvant Chemoradiotherapy ◽  
Glasgow Prognostic Score ◽  
Ductal Adenocarcinoma ◽  
Prognostic Impact ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Nutritional Factors ◽  
Neutrophil Lymphocyte Ratio

Abstract Background Inflammatory nutritional factors, such as the neutrophil/lymphocyte ratio (NLR), Glasgow Prognostic Score (GPS), modified GPS (mGPS), and C-reactive protein/albumin (CRP/Alb) ratio, have prognostic values in many types of cancer. In this study, the prognostic values of inflammatory nutritional scores were evaluated in the patients with resectable or borderline resectable pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant chemoradiotherapy (NACRT). Methods A total of 49 patients who underwent pancreatectomy after NACRT from September 2009 to May 2016 were enrolled. The NACRT consisted of hypofractionated external-beam radiotherapy (30 Gy in 10 fractions) with concurrent S-1 (60 mg/m2) delivered 5 days/week for 2 weeks before pancreatectomy. Inflammatory nutritional scores were determined before and after NACRT in this series. Results The median NLR increased after NACRT (from 2.067 to 3.302), with statistical difference (p < 0.001). In multivariate analysis, high pre-NACRT mGPS (2 or 1; p = 0.0478) and significant increase in CRP/Alb ratio after NACRT (≧ 0.077; p = 0.0036) were associated with shorter overall survival. All patients were divided into two groups according to the ΔCRP/Alb ratio after NACRT: the group with high ΔCRP/Alb ratio (≧ 0.077) and the group with low ΔCRP/Alb ratio (< 0.077). The group with high ΔCRP/Alb ratio after NACRT (n = 13) not only had higher post-NACRT CRP levels (p < 0.001) but also had lower post-NACRT Alb levels (p = 0.002). Patients in the group with high ΔCRP/Alb ratio lost more body weight during NACRT (p = 0.03). Conclusion In addition to pre-NACRT mGPS, ΔCRP/Alb after NACRT could provide prognostic value in the patients with PDAC treated by NACRT.

scholarly journals Changes and Prognostic Impact of Inflammatory Nutritional Factors During Neoadjuvant Chemoradiotherapy for Patients with Resectable and Borderline Resectable Pancreatic Cancer

2020 ◽  
Author(s):  
Minoru Oshima ◽  
Keiichi Okano ◽  
Hironobu Suto ◽  
Yasuhisa Ando ◽  
Hideki Kamada ◽  
...  
Keyword(s):  
Cox Regression ◽  
Prognostic Score ◽  
Neoadjuvant Chemoradiotherapy ◽  
Glasgow Prognostic Score ◽  
Ductal Adenocarcinoma ◽  
Prognostic Impact ◽  
Borderline Resectable ◽  
Nutritional Factors ◽  
Cox Regression Analysis ◽  
Neutrophil Lymphocyte Ratio

Abstract BackgroundInflammatory nutritional factors, such as the neutrophil/lymphocyte ratio (NLR), Glasgow Prognostic Score (GPS), modified GPS (mGPS), and C-reactive protein/albumin (CRP/Alb) ratio, have prognostic values in many types of cancer. In this study, the prognostic values of inflammatory nutritional scores were evaluated in the patients with resectable or borderline resectable pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant chemoradiotherapy (NACRT).MethodsA total of 49 patients who underwent pancreatectomy after NACRT from September 2009 to May 2016 were enrolled. The NACRT consisted of hypofractionated external-beam radiotherapy (30 Gy in 10 fractions) with concurrent S-1 (60 mg/m2) delivered 5 days/week for 2 weeks before pancreatectomy. Inflammatory nutritional scores were determined before and after NACRT in this series. ResultsThe median NLR increased after NACRT (from 2.067 to 3.302), with statistical difference (p<0.001). In multivariate Cox regression analysis, high pre-NACRT mGPS (2 or 1; p=0.0478) and significant increase in CRP/Alb ratio after NACRT (≧0.077; p=0.0036) were associated with shorter overall survival. All patients were divided into two groups according to the ΔCRP/Alb ratio after NACRT: the group with high ΔCRP/Alb ratio (≧0.077) and the group with low ΔCRP/Alb ratio (<0.077). The group with high ΔCRP/Alb ratio after NACRT (n=13) not only had higher post-NACRT CRP levels (p<0.001) but also had lower post-NACRT Alb levels (p=0.002). Patients in the group with high ΔCRP/Alb ratio lost more body weight during NACRT (p=0.03).ConclusionIn addition to pre-NACRT mGPS, ΔCRP/Alb after NACRT could provide prognostic value in the patients with PDAC treated by NACRT.

scholarly journals Prognostic impact of nutritional and inflammation-based risk scores in follicular lymphoma in the era of anti-CD20 targeted treatment strategies

2021 ◽  
Author(s):  
Niklas Gebauer ◽  
Britta Mengler ◽  
Svenja Kopelke ◽  
Alex Frydrychowicz ◽  
Alexander Fürschke ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Prognostic Index ◽  
Glasgow Prognostic Score ◽  
Risk Scores ◽  
Study Cohort ◽  
Prognostic Impact ◽  
Who Grade ◽  
Neutrophil Lymphocyte Ratio

Abstract Background The composition of the tumor microenvironment (TME) is conditioned by immunity and the inflammatory response. Nutritional and inflammation-based risk scores have emerged as relevant predictors of survival outcome across a variety of hematological malignancies. Methods In this retrospective multicenter trial, we ascertained the prognostic impact of established nutritional and inflammation-based risk scores [Glasgow Prognostic Score (GPS), C-reactive–protein/albumin ratio (CAR), neutrophil–lymphocyte ratio (NLR), prognostic nutritional index (PNI), and prognostic index (PI)] in 209 eligible patients with histologically confirmed CD20+ follicular lymphoma (FL) of WHO grade 1 (37.3%), 1–2 (16.3%), 2 (26.8%) or 3A (19.8%) admitted to the participating centers between January 2000 and December 2019. Characteristics significantly associated with overall or progression-free survival (OS, PFS) upon univariate analysis were subsequently included in a Cox proportional hazard model. Results In the study cohort, the median age was 63 (range 22–90 years). The median follow-up period covered 99 months. The GPS and the CAR were identified to predict survival in FL patients. The GPS was the only independent predictor of OS (p < 0.0001; HR 2.773; 95% CI 1.630–4.719) and PFS (p = 0.001; HR 1.995; 95% CI 1.352–2.944) upon multivariate analysis. Additionally, there was frequent occurrence of progression of disease within 24 months (POD24) in FL patients with a calculated GPS of 2. Conclusion The current results indicate that the GPS predicts especially OS in FL patients. Moreover, GPS was found to display disease-specific effects in regard to FL progression. These findings and potential combinations with additional established prognosticators should be further validated within prospective clinical trials.

scholarly journals Significance of Frailty in Prognosis After Surgery in Patients with Pancreatic Ductal Adenocarcinoma

2020 ◽  
Author(s):  
Shinichiro Yamada ◽  
Mitsuo Shimada ◽  
Yuji Morine ◽  
Satoru Imura ◽  
Tetsuya Ikemoto ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Pancreatic Resection ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Disease Free Survival ◽  
Ductal Adenocarcinoma ◽  
Albumin Concentration ◽  
Tumor Diameter ◽  
Neutrophil Lymphocyte Ratio

Abstract Background: Frailty is an important consideration for older patients undergoing surgery. We aimed to investigate whether frailty could be prognostic factor in patients with pancreatic ductal adenocarcinoma who underwent pancreatic resection.Methods: One hundred and twenty patients who underwent pancreatic resection for pancreatic ductal adenocarcinoma were enrolled. Frailty was defined as a clinical frailty scale score ≥4. Patients were divided into frailty (n = 29) and non-frailty (n=91) groups, and clinicopathological factors were compared between two groups. Results: The frailty group showed an older age, lower serum albumin concentration, lower prognostic nutritional index, larger tumor diameter, and higher rate of lymph node metastasis than the non-frailty group (p < 0.05). Neutrophil–lymphocyte ratio and modified Glasgow prognostic score tended to be higher in the frailty group. Cancer-specific and disease-free survival rates were significantly poor in the frailty group (p < 0.05). With a multivariate analysis, frailty was an independent prognostic factor of cancer-specific survival.Conclusions: Frailty can predict the prognosis of patients with pancreatic ductal adenocarcinoma who undergo pancreatic resection.

scholarly journals Significance of frailty in prognosis after surgery in patients with pancreatic ductal adenocarcinoma

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Shinichiro Yamada ◽  
Mitsuo Shimada ◽  
Yuji Morine ◽  
Satoru Imura ◽  
Tetsuya Ikemoto ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Pancreatic Resection ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Disease Free Survival ◽  
Ductal Adenocarcinoma ◽  
Albumin Concentration ◽  
Tumor Diameter ◽  
Neutrophil Lymphocyte Ratio

Abstract Background Frailty is an important consideration for older patients undergoing surgery. We aimed to investigate whether frailty could be a prognostic factor in patients with pancreatic ductal adenocarcinoma who underwent pancreatic resection. Methods One hundred and twenty patients who underwent pancreatic resection for pancreatic ductal adenocarcinoma were enrolled. Frailty was defined as a clinical frailty scale score ≥4. Patients were divided into frailty (n = 29) and non-frailty (n=91) groups, and clinicopathological factors were compared between the two groups. Results The frailty group showed an older age, lower serum albumin concentration, lower prognostic nutritional index, larger tumor diameter, and higher rate of lymph node metastasis than the non-frailty group (p < 0.05). Neutrophil–lymphocyte ratio and modified Glasgow prognostic score tended to be higher in the frailty group. Cancer-specific and disease-free survival rates were significantly poor in the frailty group (p < 0.05). With a multivariate analysis, frailty was an independent prognostic factor of cancer-specific survival. Conclusions Frailty can predict the prognosis of patients with pancreatic ductal adenocarcinoma who undergo pancreatic resection.

Prognostic value of the Memorial Sloan Kettering (MSK) prognostic score (MPS) in pancreatic ductal adenocarcinoma (PDAC).

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 133-133
Author(s):  
Justin Lebenthal ◽  
Junting Zheng ◽  
Paul A. Glare ◽  
Eileen Mary O'Reilly ◽  
Andrew S. Epstein
Keyword(s):  
Liver Metastases ◽  
Cox Regression ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Stage Iv ◽  
Ductal Adenocarcinoma ◽  
Cancer Therapies ◽  
Prognostic Tool ◽  
Neutrophil Lymphocyte Ratio ◽  
Metastatic Sites

133 Background: The MPS, a composite of the Neutrophil-Lymphocyte Ratio (NLR) and albumin, is an alternative prognostic tool to the Glasgow Prognostic Score (C-reactive protein and albumin). A retrospective analysis (jco.2016.34.26_suppl.36) of patients with PDAC suggested that the MPS predicts survival. This did not control for clinically relevant factors such as performance status (PS), metastatic sites, or cancer therapies. More discriminating prognostic tools are needed. Methods: A retrospective chart review identified patients at MSK with pathology-confirmed stage IV PDAC diagnosed from 2011 to 2014. An MPS scale of 0-2 was utilized: MPS = 0 for albumin ≥ 4 g/dl and NLR ≤ 4 g/dl, MPS = 1 for either albumin < 4 g/dl or NLR > 4 g/dl, and MPS = 2 for albumin < 4 g/dl and NLR > 4 g/dl. PS (ECOG or KPS) was abstracted from outpatient visit notes. Metastatic sites at initial MSK visit were assessed from cross-sectional imaging. Cancer therapies were characterized as 5FU-based, gemcitabine-based, experimental, and radiation to primary or metastatic sites. Thromboembolic (TE) diagnoses were also noted. Time-dependent Cox regression analyses identified clinical variables associated with overall survival (OS). Univariately significant variables were utilized in a multivariable regression model to interrogate their effect on the association of MPS and OS. Results: Univariate analyses in n = 833 stage IV PDAC patients identified higher MPS score, higher CA19-9 at diagnosis (n = 737), chemo, radiation, liver metastases, TE, hospital admission, and lower PS (n = 727) as associated with worse OS (p < 0.05). A multivariate model (n = 727) controlling for radiation, liver metastases, TE, admission, and PS demonstrated that higher MPS scores at diagnosis remained associated with worse OS (p < 0.001). Median OS in patients with MPS 0, 1, and 2 were 14.5 (95%CI: 12.9-17), 10.2 (9-11.6), and 6.2 (5.1-8.1) months, respectively. Conclusions: The MPS is an objective prognostic tool associated with OS in advanced PDAC independent of PS, disease characteristics, and types of cancer therapies. Future directions include prospective evaluation and application of the MPS to other PDAC disease settings and other malignancies.

scholarly journals Inflammation-Related Biomarkers for the Prediction of Prognosis in Colorectal Cancer Patients

2021 ◽  
Vol 22 (15) ◽  
pp. 8002
Author(s):  
Takehito Yamamoto ◽  
Kenji Kawada ◽  
Kazutaka Obama
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Albumin Concentration ◽  
Prognostic Impact ◽  
Cancer Type ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Cell Counts

Colorectal cancer (CRC) is the leading cause of cancer deaths around the world. It is necessary to identify patients with poor prognosis or with high risk for recurrence so that we can selectively perform intensive treatments such as preoperative and/or postoperative chemotherapy and extended surgery. The clinical usefulness of inflammation-related prognostic biomarkers available from routine blood examination has been reported in many types of cancer, e.g., neutrophil–lymphocyte ratio (NLR), lymphocyte–C-reactive protein ratio (LCR), platelet–lymphocyte ratio (PLR), lymphocyte–monocyte ratio (LMR), and so on. Moreover, some scoring systems based on circulating blood cell counts and albumin concentration have been also reported to predict cancer patients’ prognosis, such as the Glasgow prognostic score (GPS), systemic inflammation score (SIS), and prognostic nutritional index (PNI). The optimal biomarker and optimal cutoff value of the markers can be different depending on the cancer type. In this review, we summarize the prognostic impact of each inflammation-related marker in CRC.

scholarly journals Prognostic factors in patients admitted to an urban teaching hospital with COVID-19 infection

2020 ◽  
Author(s):  
Donogh Maguire ◽  
Marylynne Woods ◽  
Conor Richards ◽  
Ross Dolan ◽  
Jesse Wilson Veitch ◽  
...  
Keyword(s):  
Heart Failure ◽  
Medical History ◽  
Teaching Hospital ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Early Warning Score ◽  
Past Medical History ◽  
Urban Teaching ◽  
Neutrophil Lymphocyte Ratio ◽  
History Of

Abstract BackgroundSevere COVID-19 infection results in a systemic inflammatory response (SIRS). This SIRS response shares similarities to the changes observed during the peri-operative period that are recognised to be associated with the development of multiple organ failure. MethodsElectronic patient records for patients who were admitted to an urban teaching hospital during the initial 7-week period of the COVID-19 pandemic in Glasgow, U.K. (17th March 2020 - 1st May 2020) were examined for routine clinical, laboratory and clinical outcome data. Age, sex, BMI and documented evidence of COVID-19 infection at time of discharge or death certification were considered minimal criteria for inclusion.ResultsOf the 224 patients who fulfilled the criteria for inclusion, 52 (23%) had died at 30-days following admission. COVID-19 related respiratory failure (75%) and multiorgan failure (12%) were the commonest causes of death recorded. Age>70 years (p<0.001), past medical history of cognitive impairment (p<0.001), previous delirium (p<0.001), clinical frailty score>3 (p<0.001), hypertension (p<0.05), heart failure (p<0.01), national early warning score (NEWS) >4 (p<0.01), positive CXR (p<0.01), and subsequent positive COVID-19 swab (p<0.001) were associated with 30-day mortality. CRP>80 mg/L (p<0.05), albumin <35g/L (p<0.05), peri-operative Glasgow Prognostic Score (poGPS) (p<0.05), lymphocytes <1.5 109/l (p<0.05), neutrophil lymphocyte ratio (p<0.001), haematocrit (<0.40 L/L (male) / <0.37 L/L (female)) (p<0.01), urea>7.5 mmol/L (p<0.001), creatinine >130 mmol/L (p<0.05) and elevated urea: albumin ratio (<0.001) were also associated with 30-day mortality.On analysis, age >70 years (O.R. 3.9, 95% C.I. 1.4 – 8.2, p<0.001), past medical history of heart failure (O.R. 3.3, 95% C.I. 1.2 – 19.3, p<0.05), NEWS >4 (O.R. 2.4, 95% C.I. 1.1 – 4.4, p<0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2-0.9, p<0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1 – 4.4, p<0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n=122), age >70 years (O.R. 4.7, 95% C.I. 2.0 - 11.3, p<0.001), past medical history of heart failure (O.R. 4.4, 95% C.I. 1.2 – 20.5, p<0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1- 5.1, p<0.05) remained independently associated with 30-days mortality.ConclusionAge > 70 years and severe systemic inflammation as measured by the peri-operative Glasgow Prognostic Score are independently associated with 30-day mortality among patients admitted to hospital with COVID-19 infection.

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