Prognostic value of preoperative glucose to lymphocyte ratio in patients with resected pancreatic cancer
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ORIGINAL ARTICLE
Prognostic value of preoperative glucose to lymphocyte ratio in patients with resected pancreatic cancer Yueming Zhang1 · Yaolin Xu1 · Dansong Wang1 · Tiantao Kuang1 · Wenchuan Wu1 · Xuefeng Xu1 · Dayong Jin1 · Wenhui Lou1 Received: 25 May 2020 / Accepted: 31 August 2020 © Japan Society of Clinical Oncology 2020
Abstract Background Inflammatory factors and fasting blood glucose were verified to be associated with the prognosis of pancreatic ductal adenocarcinoma. The goal of this study is to confirm the prognostic role of preoperative blood glucose to lymphocyte ratio for patients with resected pancreatic ductal adenocarcinoma. Methods A total of 259 pancreatic ductal adenocarcinoma patients were enrolled and randomly divided into training cohort and validation cohort. The training cohort was used to generate an optimal cutoff value and the validation cohort was used to further validate the model. Results A total of 259 patients were incorporated in this study and randomly divided into the training cohort (n = 130, 1/2 of 259) and the validation cohort (129, 1/2 of 259). The optimal cutoff value of glucose to lymphocyte ratio was calculated to be 3.47 for overall survival. Cox regression analysis found that preoperative blood glucose to lymphocyte ratio was independent risk factor (p = 0.040) for overall survival. Prognostic values of glucose to lymphocyte ratio on overall survival were observed in younger male patients with pancreatic body and tail cancer, American Joint Committee on Cancer 8th N1 stage, without microvascular and peripancreatic fat invasion, and Carbohydrate antigen 19–9 higher than 200 U/ml. A prognostic prediction model of overall survival was designed and presented in nomogram. Conclusion Preoperative blood glucose to lymphocyte ratio is an independent biomarker to predict the overall survival for pancreatic ductal adenocarcinoma patients who underwent curative resection. Keywords Pancreatic ductal adenocarcinoma · Glucose to lymphocyte ratio · Overall survival · Prognosis
Introduction Pancreatic ductal adenocarcinoma (PDAC) is one of the most fatal malignant tumors with poor prognosis. Surgical resection is still the primary treatment for PDAC, but most patients cannot be diagnosed until advanced stage and only 10–20% could receive surgery [1]. Even if curative surgery is performed, 80% of patients subsequently develop local
Yueming Zhang and Yaolin Xu contributed equally to this work and should be considered co-first authors. * Wenhui Lou lou.wenhui@zs‑hospital.sh.cn 1
Department of General Surgery, Zhongshan Hospital Fudan University, Ward 9, Building No.1, 180 Fenglin Road, Shanghai, China
or systemic recurrence [2]. The overall 5 year survival rate is 8% [3]. Carbohydrate antigen 19-9 (CA 19-9), first isolated in 1979 [4, 5], is the only available serum biomarker for PDAC and has shown some value as a prognostic marker [6, 7]. However, it can yield false negative results in patients who do not express the Lewis blood antigen, which accounted from 5–10% in g
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