Performance of nutritional and inflammatory markers in patients with pancreatic cancer

doi:10.5306/wjco.v15.i8.1021

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World Journal of Clinical Oncology

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Clin Oncol. Aug 24, 2024; 15(8): 1021-1032
Published online Aug 24, 2024. doi: 10.5306/wjco.v15.i8.1021

Table 1 Characteristics of the total cohort

Characteristics	Total cohort (n = 446)
Demographics
Age (years)	65.09 ± 8.93
Male	246 (55.2%)
Female	200 (44.8%)
BMI (kg/m²)	22.67 ± 3.00
Smoke	166 (37.2%)
Hypertension	209 (46.9%)
Diabetes	130 (29.1%)
Tumor biomarkers
sCA19-9 (U/mL)
≥ 37	336 (75.3%)
< 37	102 (22.9%)
Unknow	8 (1.8%)
sCA125 (U/mL)
≥ 35	83 (18.6%)
< 35	341 (76.5%)
Unknow	22 (4.9%)
Tumor features
Location
Head	217 (48.7%)
Neck	29 (6.5%)
Body	69 (15.5%)
Tail	58 (13.0%)
Both body and tail	50 (11.2%)
Others	23 (5.2%)
Degree of differentiation
Poor	142 (31.8%)
Moderate	239 (53.6%)
Well	43 (9.6%)
Unknow	22 (4.9%)
TNM stage
Ⅰ	198 (44.4%)
Ⅱ	139 (31.2%)
Ⅲ	58 (13.0%)
Ⅳ	51 (11.4%)
Surgical information
Main surgical procedure
Pancreaticoduodenectomy	230 (51.6%)
Pancreaticocaudectomy	191 (42.8%)
Others	25 (5.6%)
Method of surgery
Laparoscope	162 (36.3%)
Open	284 (63.7%)
Time of surgery (min)	295 (225-395)
Bleeding (mL)	200 (100-300)
Inflammatory-nutritional markers
AGR	1.42 (1.27-1.59)
PNI	47.75 (43.89-51.11)
SII	563.12 (367.88-894.94)
NLR	2.74 (2.13-3.97)
PLR	146.88 (107.55-195.98)
NRI	104.02 (97.85-109.90)
GNRI	102.86 (96.74-108.59)
Hospital stays (days)	17.68 ± 12.72

Data are presented as mean ± SD, median (IQR) or n (%). AGR: Albumin to globulin ratio; BMI: Body mass index; GNRI: Geriatric nutritional risk index; NLR: Neutrophil to lymphocyte ratio; NRI: Nutritional risk index; PLR: Platelet to lymphocyte ratio; PNI: Prognostic nutrition index; sCA19-9: Serum carbohydrate antigen 19-9; sCA125: Serum carbohydrate antigen 125; SII: Systemic immune-inflammation index.

Table 2 Difference between early and delayed discharge cohort with a cut-off of 15-day postoperative discharge

Characteristics	Early discharge cohort (n = 259)	Delayed discharge cohort (n = 187)	P value
Demographics
Age (years)	64.01 ± 8.57	66.58 ± 9.23	0.003^b
Gender (male/female)	147/112	99/88	0.424
BMI (kg/m²)	22.76 ± 3.12	22.54 ± 2.81	0.453
Smoke (yes/no)	103/156	63/124	0.190
Hypertension (yes/no)	108/151	101/86	0.010^a
Diabetes (yes/no)	67/192	63/124	0.073
Tumor features
Location			< 0.001^c
Head	90	127
Neck	23	6
Body	53	16
Tail	45	13
Both body and tail	35	15
Others	13	10
Degree of differentiation			0.320
Poor	85	57
Moderate	132	107
Well	30	13
Unknow	12	10
TNM stage			0.942
Ⅰ	116	82
Ⅱ	80	59
Ⅲ	32	26
Ⅳ	31	20
Surgical information
Main surgical procedure			< 0.001^c
Pancreaticoduodenectomy	98	132
Pancreaticocaudectomy	143	48
Others	18	7
Method of surgery			< 0.001^c
Laparoscope	113	49
Open	146	138
Time of surgery (min)	282.61 ± 116.72	354.89 ± 124.67	< 0.001^c
Bleeding (mL)	198.38 ± 168.88	218.29 ± 150.36	0.199
Inflammatory-nutritional markers
AGR	1.42 ± 0.24	1.44 ± 0.25	0.337
PNI	47.84 ± 5.72	46.43 ± 5.41	0.008^b
SII	643.27 ± 476.16	815.72 ± 660.21	0.003^b
NLR	3.13 ± 1.96	3.67 ± 2.20	0.007^b
PLR	149.93 ± 70.93	174.77 ± 79.25	< 0.001^c
NRI	103.90 ± 9.50	102.44 ± 8.93	0.102
GNRI	102.69 ± 9.40	101.26 ± 8.82	0.103

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

Data are presented as mean ± SD. AGR: Albumin to globulin ratio; BMI: Body mass index; GNRI: Geriatric nutritional risk index; NLR: Neutrophil to lymphocyte ratio; NRI: Nutritional risk index; PLR: Platelet to lymphocyte ratio; PNI: Prognostic nutrition index; SII: Systemic immune-inflammation index.

Table 3 Multivariable logistic regression analysis between clinical characteristics and recovery

Characteristics	OR (95%CI)	P value
Age (years)	1.037 (1.013-1.063)	0.003^b
Main surgical procedure (Pancreaticocaudectomy vs Pancreaticoduodenectomy)	0.366 (0.217-0.618)	< 0.001^c
Time of surgery (h)	1.172 (1.032-1.332)	0.015^a
Ln (SII)	1.407 (1.006-1.969)	0.046^a

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

Ln (SII) refers to the natural log-transformed value of the systemic immune-inflammation index.

Table 4 Univariable and multivariable Cox regression analysis of recurrence-free survival

Characteristics	Univariable analysis		Multivariable analysis
Characteristics	HR	P value	HR	P value
Demographics
Age (years)	1.001 (0.985-1.018)	0.862
Gender (male/female)	1.071 (0.804-1.425)	0.641
BMI (kg/m²)	0.973 (0.929-1.018)	0.232
Smoke (yes/no)	1.007 (0.748-1.356)	0.963
Hypertension (yes/no)	0.829 (0.623-1.104)	0.199
Type 2 diabetes (yes/no)	0.923 (0.678-1.257)	0.610
Tumor biomarkers
sCA19-9 (U/mL) ≥ 37 vs < 37	1.164 (0.821-1.652)	0.394
sCA125 (U/mL) ≥ 35 vs < 35	1.277 (0.892-1.828)	0.181
Tumor features
Location (body/tail vs head/neck)	0.854 (0.636-1.146)	0.293
Degree of differentiation		0.014^a
Poor	2.455 (1.321-4.565)	0.005^e
Moderate	1.908 (1.048-3.474)	0.035^d
Well	Reference
Tumor stage (TNM)		< 0.001^c		< 0.001^c
Early stage (Ⅰ)	0.397 (0.253-0.621)	< 0.001^f	0.384 (0.241-0.612)	< 0.001^f
Middle stage (Ⅱ/Ⅲ)	0.640 (0.413-0.993)	0.046^d	0.613 (0.388-0.967)	0.035^d
Advanced stage (Ⅳ)	Reference
Inflammatory-nutritional markers
AGR	0.887 (0.488-1.611)	0.694
Ln (PNI)	0.203 (0.062-0.665)	0.008^b	0.256 (0.076-0.863)	0.028^a
Ln (SII)	1.276 (1.019-1.597)	0.034^a
Ln (NLR)	1.439 (1.102-1.880)	0.008^b
Ln (PLR)	1.443 (1.033-2.016)	0.031^a
Ln (NRI)	0.299 (0.066-1.352)	0.117
Ln (GNRI)	0.299 (0.066-1.353)	0.117

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

^dP < 0.05 vs reference.

^eP < 0.01 vs reference.

^fP < 0.001 vs reference.

AGR: Albumin to globulin ratio; BMI: Body mass index; GNRI: Geriatric nutritional risk index; HR: Hazard ratio; NLR: Neutrophil to lymphocyte ratio; NRI: Nutritional risk index; PLR: Platelet to lymphocyte ratio; PNI: Prognostic nutrition index; sCA19-9: Serum carbohydrate antigen 19-9; sCA125: Serum carbohydrate antigen 125; SII: Systemic immune-inflammation index. Ln (PNI), Ln (SII), Ln (NLR), Ln (PLR), Ln (NRI) and Ln (GNRI) refers to the natural log-transformed value of the inflammatory-nutritional markers respectively.

Table 5 Univariable and multivariable Cox regression analysis of overall survival

Characteristics	Univariable analysis		Multivariable analysis
Characteristics	HR	P value	HR	P value
Demographics
Age (years)	1.027 (1.009-1.046)	0.004^b	1.021 (1.000-1.041)	0.046^a
Gender (male/female)	1.148 (0.845-1.561)	0.377
BMI (kg/m²)	0.932 (0.886-0.980)	0.006^b
Smoke (yes/no)	1.280 (0.941-1.740)	0.115
Hypertension (yes/no)	0.843 (0.621-1.145)	0.275
Type 2 diabetes (yes/no)	0.996 (0.718-1.382)	0.982
Tumor biomarkers
sCA19-9 (U/mL) ≥ 37 vs < 37	1.283 (0.880-1.871)	0.195
sCA125 (U/mL) ≥ 35 vs < 35	1.413 (0.974-2.049)	0.068
Tumor features
Location (body/tail vs head/neck)	0.663 (0.482-0.911)	0.011^a
Degree of differentiation		0.003^b		0.012^a
Poor	2.804 (1.433-5.487)	0.003^e	2.369 (1.200-4.675)	0.013^d
Moderate	1.899 (0.985-3.661)	0.056	1.592 (0.822-3.084)	0.168
Well	Reference
Tumor stage (TNM)		< 0.001^c		0.001^c
Early stage (Ⅰ)	0.405 (0.260-0.632)	< 0.001^f	0.448 (0.281-0.715)	< 0.001^f
Middle stage (Ⅱ/Ⅲ)	0.725 (0.474-1.109)	0.138	0.737 (0.473-1.149)	0.178
Advanced stage (Ⅳ)	Reference
Inflammatory-nutritional markers
AGR	0.415 (0.212-0.813)	0.010^a
Ln (PNI)	0.025 (0.008-0.079)	< 0.001^c	0.048 (0.015-0.155)	< 0.001^c
Ln (SII)	1.432 (1.122-1.829)	0.004^b
Ln (NLR)	1.788 (1.344-2.378)	< 0.001^c
Ln (PLR)	1.839 (1.277-2.647)	0.001^b
Ln (NRI)	0.018 (0.004-0.078)	< 0.001^c
Ln (GNRI)	0.018 (0.004-0.079)	< 0.001^c

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

^dP < 0.05 vs reference.

^eP < 0.01 vs reference.

^fP < 0.001 vs reference.

Citation: Lu JN, Zhou LS, Zhang S, Li JX, Xu CJ. Performance of nutritional and inflammatory markers in patients with pancreatic cancer. World J Clin Oncol 2024; 15(8): 1021-1032
URL: https://www.wjgnet.com/2218-4333/full/v15/i8/1021.htm
DOI: https://dx.doi.org/10.5306/wjco.v15.i8.1021