Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios at the time of chemoradiation to predict survival in resected pancreatic cancer patients.

452 Background: Higher pre-treatment neutrophil-to-lymphocyte ratio (NLR) and lower platelet-to-lymphocyte ratio (PLR) are independent predictors for worse survival in cancer patients. The effect of chemoradiation (CRT) on NLR and PLR in pancreatic cancer patients who also undergo surgical resection has not been reported. Methods: A retrospective review was performed of pancreatic cancer patients treated at our institution with CRT either prior to or after surgery with curative intent. Overall survival was evaluated using Kaplan-Meier method. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of NLR and PLR. Results: After excluding patients who did not have surgery, who received palliative radiation doses, or who had incomplete medical records, 81 out of 282 patients remained with median age 62 years (35-86). Of these, 24 (29.6%) were borderline resectable (BR) and received preoperative CRT while 57 (70.4%) received adjuvant CRT. Median total dose and number of fractions were 50.4 Gy (30-59.4) and 28 (5-33), respectively. Median pre-CRT and post-CRT NLR were 2.9 and 7.8, respectively. Median pre-CRT and post-CRT PLR were 211.3 and 457.5, respectively. Most patients had a decrease in NLR (85.2%) and PLR (72.8%) after CRT, with median changes of -4.95 for NLR and -178.33 for PLR. Cox proportional hazards analysis showed a trend towards significance for pre-CRT NLR (p=.08) regarding OS. A significant relationship was found between relapse free survival and both pre-CRT NLR (p=0.02) and PLR (p=0.01). The difference or percent change of neither NLR nor PLR was found to correlate with clinical outcomes. Conclusions: This is the first study to evaluate the effect of CRT on NLR and PLR in resected pancreas cancer patients. Similar to other reports, our data indicate that a significant relationship exists between NLR, PLR, and clinical outcomes. Identification of clinically meaningful NLR and PLR cut-off points for resected pancreatic cancer patients who also receive CRT is needed.

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Changes in neutrophil-to-lympocyte and platelet-to-lymphocyte ratios to predict survival and pathologic complete response in esophageal cancer patients who receive trimodality therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.170 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 170-170

Author(s):

Jalal Hyder ◽

Drexell Boggs ◽

Andrew Hanna ◽

Mohan Suntharalingam ◽

Michael David Chuong

Keyword(s):

Esophageal Cancer ◽

Cancer Patients ◽

Cox Regression ◽

Locally Advanced ◽

Pathologic Complete Response ◽

Prognostic Significance ◽

Progression Free Survival ◽

Complete Response ◽

Trimodality Therapy ◽

Lymphocyte Ratio

170 Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) predict for survival in cancer patients. In patients receiving multi-modality therapy, the effect of each specific therapy on the NLR and PLR is not well understood. We therefore evaluated changes in NLR and PLR among locally advanced esophageal cancer patients who received trimodality therapy. Methods: We performed a retrospective analysis of non-metastatic patients with esophageal cancer who received neoadjuvant chemoradiation (CRT) followed by esophagectomy at our institution between March 2000 and April 2012. NLR and PLR values were obtained the following time points (TP): 1) at diagnosis before CRT, 2) after CRT prior to surgery, and 3) after surgery. We also evaluated change in NLR and PLR using the difference and ratio between TPs. Overall survival (OS) was evaluated by Kaplan-Meier analysis. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of NLR and PLR. Results: 83 patients with stage II-IV esophageal cancer and median age 60 years were included. Median follow up was 29.3 months. Median dose of 50.4 Gy (50.4-59.4) in 28 fractions (28-33) was used. Median NLR and PLR at the each TP: 1) 3.3 and 157.2, 2) 12 and 645, and 11.5 and 391.7, respectively. On multivariate analysis, inferior OS was associated with PLR ≥250 at TP 3 (p=.03), PLR decrease ≥609.2 from TP 2-3 (p=.02), and PLR ratio (TP 1/TP3) ≥1.08 (p=.03). Inferior progression free survival (PFS) was associated with NLR at TP 2 ≥36 (p=.0008), NLR increase ≥28.3 from TP 1-2 (p=.0005), PLR increase from TP 1-3 ≥19 (p=.01), and PLR ratio (TP 2/TP 3) ≥0.34 (p=0.1). Pathologic complete response (pCR) was less likely for adenocarcinoma histology (p=.03), NLR at TP 2 ≥10.6 (p=.04), and NLR increase from TP 1 to TP 2 ≥4.6 (p=.03). Conclusions: This is the first study to demonstrate that changes in NLR and PLR throughout trimodality therapy for esophageal cancer correlate with OS, PFS, and pCR. Further evaluation is warranted to better define which of the identified cut-off values are most clinically significant.

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The neutrophil to lymphocyte ratio as a prognostic factor among a diverse population with advanced pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e15729 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e15729-e15729

Author(s):

Michael Shusterman ◽

Erin Jou ◽

Andreas Kaubisch ◽

Jennifer W. Chuy ◽

Lakshmi Rajdev ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Metastatic Disease ◽

Proportional Hazards ◽

Univariate Analysis ◽

Prognostic Significance ◽

Advanced Pancreatic Cancer ◽

Cox Proportional Hazards ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio

e15729 Background: The neutrophil to lymphocyte ratio (NLR), a marker of systemic inflammatory response, has been suggested as a prognostic marker in patients with pancreatic adenocarcinoma (PAC). Black and Hispanic patients have been underrepresented in studies evaluating the significance of NLR in PAC. We investigated the prognostic significance of NLR in patients with advanced PAC treated at the Montefiore-Einstein Center for Cancer Care (MECCC) in the Bronx, NY. Methods: We included patients who were chemotherapy naive and treated for unresectable or metastatic PAC at MECCC between 2006 and 2015. Demographics, clinical characteristics and treatment data were collected. Overall survival was determined by the Kaplan-Meier method and Cox proportional-hazards models were built to assess survival differences adjusting for clinically relevant and statistically significant variables. Results: 201 patients were included in the study. Median age was 65 (range 32, 90). 52% were male. 41 were White (19%), 71 Black (33%), 71 Hispanic (33%), and 33 Other (15.3%). 66 (30.6%) had unresectable disease and 135 (62.5%) metastatic disease. An NLR ≥ 4 was associated with a worse OS compared to an NLR ≤ 4 (median 10 vs. 16.4 months; HR 1.895; 95% CI 1.390, 2.585; P < 0.0001). Predictors of worse OS on univariate analysis were ever smoker status (HR 1.365; P = 0.05), metastatic disease (HR 1.736; P = 0.001), and albumin ≤ 3.5 g/dL (HR 2.558; P< 0.0001). An NLR ≥ 4 on multivariate analysis remained significantly associated with worse OS (HR 1.665; 95% CI 1.188, 2.334; P = 0.003) after adjusting for age, gender, ever smoker status, metastatic disease, and albumin. Conclusions: In a cohort with significant minority patient representation, an NLR ≥ 4 was associated with significantly worse overall survival in patients with advanced pancreatic cancer. An elevated NLR in advanced PAC may be an important independent predictor to risk stratify patients and predict poor OS in future analyses.

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Neoadjuvant FOLFIRINOX versus adjuvant gemcitabine in pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.4123 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 4123-4123 ◽

Cited By ~ 1

Author(s):

Adam R Wolfe ◽

Eric David Miller ◽

Laith I. Abushahin ◽

Jordan Cloyd ◽

Adrei Manilchuck ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cancer Patients ◽

Randomized Clinical Trials ◽

Cox Regression ◽

Performance Status ◽

Disease Free Survival ◽

Hazard Ratio ◽

Tumor Board ◽

Rank Test ◽

Borderline Resectable

4123 Background: In the metastatic or adjuvant setting for pancreatic cancer, the combination chemotherapy of fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) resulted in longer overall survival (OS) compared to gemcitabine therapy. We conducted an institutional study to compare the efficacy of neoadjuvant modified FOLFIRINOX (neo-mFOLFIRINOX) to adjuvant gemcitabine (adj-gem) for pancreatic cancer patients who completed resection. Methods: The study retrospectively enrolled patients from 2006 to 2017 from Ohio State University. While patients who received adjuvant gemcitabine were considered to be resectable upfront, patients who received neo-mFOLFIRINOX were either staged as borderline resectable (BR) or un-resectable (UR) by the institutional tumor board group. 111 patients received adj-gem (average cycles, 5.5) and 52 patients received neo-mFOLFIRINOX (average cycles, 3.5). The survival rates were determined by the Kaplan-Meier method and analyzed using Cox regression and log-rank test. Results: At a median follow up of 21.3 months, the median OS was 35.4 months in the neo-mFOLFIRINOX group and 21.8 months in the adj-gem group (hazard ratio, 0.56, 95% confidence interval (CI), 0.37-0.84 p = 0.005). The OS rate at 3 years was 46% in the neo-mFOLFIRINOX group and 22% in the adjuvant gemcitabine group (p = 0.001). The median disease free survival (DFS) was 18.6 months in the neo-mFOLFIRINOX group and 12.0 months in the adj-gem group (hazard ratio, 0.63, 95% CI, 0.43-0.93 p = 0.022). The DFS rate at 3 years was 17% in the neo-mFOLFIRINOX group and 11% in the adj-gem group (p = 0.02). On surgical pathological specimen review, the neo-mFOLFIRINOX group had statistically (p < 0.05) lower tumor grade, lower rates of perineural invasion and lymphovascular invasion, lower pathological T stage, lower pathological N stage, and lower number of nodes positive compared to the adj-gem group. Frequencies of obtaining R0 resections were higher in the neo-mFOLFIRINOX versus adj-gem groups but not statistically different (51.9% vs 40.4, p = 0.2). The average age and performance status were similar between the two groups. Conclusions: At our institution, BR and UR pancreatic cancer patients who received neo-mFOLFIRINOX and completed resection had longer OS, DFS, and more favorable pathological indicators compared to those patients who had upfront surgery and adjuvant gemcitabine. Randomized clinical trials comparing neoadjuvant versus adjuvant FOLFIRINOX are needed to validate these findings.

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High neutrophil-to-lymphocyte ratio following stereotactic body radiation therapy is associated with poor clinical outcomes in patients with borderline resectable and locally advanced pancreatic cancer

Journal of Gastrointestinal Oncology ◽

10.21037/jgo-21-513 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Abhinav V. Reddy ◽

Colin S. Hill ◽

Shuchi Sehgal ◽

Jin He ◽

Lei Zheng ◽

...

Keyword(s):

Pancreatic Cancer ◽

Radiation Therapy ◽

Clinical Outcomes ◽

Stereotactic Body Radiation Therapy ◽

Locally Advanced ◽

Advanced Pancreatic Cancer ◽

Locally Advanced Pancreatic Cancer ◽

Borderline Resectable ◽

Lymphocyte Ratio ◽

Stereotactic Body Radiation

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The Prognostic Significance of Anisomycin-Activated Phospho-c-Jun NH2-Terminal Kinase (p-JNK) in Predicting Breast Cancer Patients’ Survival Time

Frontiers in Cell and Developmental Biology ◽

10.3389/fcell.2021.656693 ◽

2021 ◽

Vol 9 ◽

Author(s):

Li Chen ◽

Xuantong Zhou ◽

Xiangyi Kong ◽

Zhaohui Su ◽

Xiangyu Wang ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Cox Regression ◽

Prognostic Significance ◽

Disease Free Survival ◽

Cox Proportional Hazards ◽

Breast Cancer Cell Lines ◽

Rank Test ◽

Significant Prognostic Factor ◽

Breast Cancer Patients

This study aims to investigate the prognostic significance of p-JNK in breast cancer patients receiving neoadjuvant chemotherapy (NACT) and analyze the relationship between anisomycin, p-JNK. A total of 104 breast cancer patients had NACT were enrolled in this study. The western blot and immunohistochemistry assays were used to determine the protein expressions of p-JNK in human breast cancer cell lines and patients’ cancer tissues. The chi-square test and Fisher’s exact test were adopted to gauge the associations between breast cancer and clinicopathological variables by p-JNK expression, whereas the univariate and multivariate Cox proportional hazards regression models were used to analyze the prognostic value of p-JNK expression. The Kaplan-Meier plots and the log-rank test were adopted to determine patients’ disease-free survival (DFS) and overall survival (OS). Findings indicated that the p-JNK expression had prognostic significance in univariate and multivariate Cox regression survival analyses. Results of log-rank methods showed that: (1) the mean DFS and OS times in patients with high p-JNK expression were significantly longer than those in patients with low p-JNK expression (χ2 = 5.908, P = 0.015 and χ2 = 6.593, P = 0.010, respectively). p-JNK expression is a significant prognostic factor that can effectively predict the survival in breast cancer patients receiving NACT. Treatment with the JNK agonist anisomycin can induce apoptosis, lead to increased p-JNK expression and decreased p-STAT3 expression. Moreover, the p-JNK expression was inversely correlated with p-STAT3 expression.

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The association between sarcopenia and treatment outcomes in patients with pancreatic cancer undergoing chemoradiation.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.415 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 415-415

Author(s):

Kajal Patel ◽

Talha Shaikh ◽

Lora S Wang ◽

John Parker Hoffman ◽

Steven J. Cohen ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cancer Patients ◽

Cox Regression ◽

Locally Advanced ◽

Multivariable Analysis ◽

Categorical Variables ◽

Cancer Center ◽

Borderline Resectable ◽

T Stage ◽

Pre Treatment

415 Background: Sarcopenia (Sp) or severe loss of muscle mass is a prognostic factor in cancer patients. We assessed the association between Sp and outcomes in borderline resectable or locally advanced/unresectable pancreatic cancer patients undergoing chemoradiation (CRT). Methods: We reviewed all patients who underwent CRT at an NCI-designated cancer center between 2007-2012. Patients with available pre-treatment imaging were included in the analysis. Sp was defined as a lumbar skeletal muscle area/height of < 55.4 cm2/m2 for males and < 38.9 cm2/m2for females. Sp was correlated to treatment toxicity, cause specific survival (CSS), and overall survival (OS). Analysis was performed using chi-square test for categorical variables and Mann-Whitney U test for continuous variables. Kaplan-Meier method and Cox regression was used for survival analysis. Results: A total of 86 patients met the inclusion criteria with 32 (37%) patients being sarcopenic. The median age was 70 (range 46-91) with a median follow-up of 14 months (3-68). The majority of patients were male (57%), had T3 disease (47%), or were borderline resectable (63%). Twenty nine (33.7%) patients underwent surgery. Sarcopenic patients were less likely to undergo surgery (p = 0.024) versus non-sarcopenic patients. Otherwise there was no difference in clinical or treatment factors. The 12-month actuarial OS for patients with and without Sp was 47.9% and 70.7%, respectively (p = 0.047). The 12-month actuarial CSS for patients with and without Sp was 48% and 76%, respectively (p = 0.007). On multivariable analysis, after controlling for T-stage, N-stage, resectability, gender, pre-treatment CA 19-9, and surgery, Sp was no longer associated with CSS (HR 0.284 95% CI 0.774-2.398) or OS (HR 1.077 95% CI 0.626-1.853). Surgery remained associated with CSS (HR 0.205 95% CI = 0.102-0.412) and OS (HR 0.187 95% CI 0.096-0.363). T-stage also remained associated with both CSS (HR 0.616 95% CI 0.410-0.925) and OS (HR 0.649 95% CI 0.440-0.957). Conclusions: The presence of Sp decreases the likelihood of undergoing curative surgery for pancreatic cancer. This may be another useful tool to identify poor prognosis patients.

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