e-Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2021

The role of inflammatory biomarkers in prediction of chemotherapy response and prognosis for patients diagnosed with pancreatic cancer (#236)

Sarah Maloney 1 2 , Nick Pavlakis 1 2 , Malinda Itchins 1 2 , Jenny Arena 1 3 , Anubhav Mittal 2 3 , Jaswinder Samra 2 3 , Stephen Clarke 1 2
  1. Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
  2. Kolling Institute, University of Sydney, Royal North Shore, St Leonards, NSW, Australia
  3. Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia

Background

Inflammatory markers including neutrophils, lymphocytes, platelets, and monocytes have been used in recent years to assist in prognostication in advanced malignancies including pancreatic cancer1, 2.  High neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and lymphocyte monocyte ratio (LMR) are associated with worse outcomes due to the relationship between aggressive disease and systemic inflammation3. Our aim was to identify if these markers were useful in predicting chemotherapy response as well as prognosis in patients that underwent surgery for pancreatic cancer.

Methods

Using surgical, chemotherapy and multidisciplinary databases 196 patient records from 2013-2020 that underwent resection at one high volume pancreatic cancer centre were analysed. Charlestown co-morbidity, performance status, upfront resectability and upfront radiological staging were collected for all patients at diagnosis. One-hundred and ten patients were treated with neoadjuvant chemotherapy (NAC) and 86 received upfront surgery. Bloods taken at time of diagnosis and the residual tumour from time of surgery were evaluated.  

Results

For the 110 patients that received NAC we discovered that higher PLR was associated with higher residual tumour at time of surgery and hence poorer response to chemotherapy (p=0.02). Clinical markers including more advanced disease at diagnosis also predicted for higher residual tumour on the surgical specimen following NAC (p=0.014). For all 196 patients higher NLR (p<0.001) and PLR (0.042) were associated with shorter overall survival whereas LMR (p=0.78) was not a useful biomarker. Interestingly these biomarkers were not useful in predicting progression free survival.

Conclusion

Routinely tested inflammatory markers from patients with pancreatic cancer collected at time of diagnosis can be used to predict for chemotherapy response to neoadjuvant chemotherapy and for prognosis. High PLR was associated with higher residual tumour at time of surgery (after NAC) and high NLR and PLR were associated with shorter overall survival.

 

  1. Piciucchi, M.;Stigliano, S.;  Archibugi, L.;  Zerboni, G.;  Signoretti, M.;  Barucca, V.;  Valente, R.; Fave, G. D.; Capurso, G., The Neutrophil/Lymphocyte Ratio at Diagnosis Is Significantly Associated with Survival in Metastatic Pancreatic Cancer Patients. Int J Mol Sci 2017, 18 (4), 730.
  2. Ventriglia, J.;Petrillo, A.;  Huerta Alváro, M.;  Laterza, M. M.;  Savastano, B.;  Gambardella, V.;  Tirino, G.;  Pompella, L.;  Diana, A.;  Iovino, F.;  Troiani, T.;  Martinelli, E.;  Morgillo, F.;  Orditura, M.;  Cervantes, A.;  Ciardiello, F.; De Vita, F., Neutrophil to Lymphocyte Ratio as a Predictor of Poor Prognosis in Metastatic Pancreatic Cancer Patients Treated with Nab-Paclitaxel plus Gemcitabine: A Propensity Score Analysis. Gastroenterology Research and Practice 2018, 2018, 2373868.
  3. Inman, K. S.;Francis, A. A.; Murray, N. R., Complex role for the immune system in initiation and progression of pancreatic cancer. World J Gastroenterol 2014, 20 (32), 11160-11181.