The Systemic-immune-inflammation Index Independently Predicts Survival and Recurrence in Resectable Pancreatic Cancer and its Prognostic Value Depends on Bilirubin Levels
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- Mohammad Hosein Aziz
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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- Kostandinos Sideras
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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- Nasir Ahmad Aziz
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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- Katya Mauff
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
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- Roel Haen
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
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- Daphne Roos
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
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- Lawlaw Saida
- Department of Health Sciences, Vrije Universiteit, Amsterdam, the Netherlands
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- Mustafa Suker
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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- Erwin van der Harst
- Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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- Jan Sven Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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- Bert A. Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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- Yarne Klaver
- Department of Medical Oncology, Laboratory of Tumor Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands.
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- Bas Groot Koerkamp
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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- Casper H. van Eijck
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
書誌事項
- タイトル別名
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- A Retrospective Multicenter Cohort Study
抄録
<jats:sec> <jats:title>Objective:</jats:title> <jats:p>Our aim was to determine the prognostic significance of the systemic-immune-inflammation index (SIII) in patients with resectable pancreatic cancer, using cancer-specific survival as the primary outcome.</jats:p> </jats:sec> <jats:sec> <jats:title>Background:</jats:title> <jats:p>Pancreatic cancer is associated with a dysfunctional immune system and poor prognosis. We examined the prognostic significance of the SIII in patients with resectable pancreatic ductal adenocarcinoma (PDAC) and the effects of bilirubin on this index.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>We retrospectively assessed all pancreatic resections performed between 2004 and 2015 at 4 tertiary referral centers to identify pathologically confirmed PDAC patients. Baseline clinicopathologic characteristics, preoperative laboratory values such as absolute neutrophil, lymphocyte, and platelet counts, C-reactive protein, albumin, bilirubin, and CA19-9 levels, and also follow-up information, were collected. The associations of the calculated inflammatory indices with outcome were both internally and externally validated.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>In all, 590 patients with resectable PDAC were included. The discovery and validation cohort included 170 and 420 patients, respectively. SIII >900 [hazard ratio (HR) 2.32, 95% confidence interval (CI) 1.55–3.48], lymph node ratio (HR 3.75, 95% CI 2.08–6.76), and CA19.9 >200 kU/L (HR 1.62, 95% CI 1.07–2.46) were identified as independent predictors of cancer-specific survival. Separate model analysis confirmed that preoperative SIII contributed significantly to prognostication. However, SIII appeared to lose its prognostic significance in patients with bilirubin levels above 200 μmol/L.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>SIII is an independent predictor of cancer-specific survival and recurrence in patients with resectable PDAC. SIII may lose its prognostic significance in patients with high bilirubin levels. Properly designed prospective studies are needed to further confirm this hypothesis.</jats:p> </jats:sec>
収録刊行物
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- Annals of Surgery
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Annals of Surgery 270 (1), 139-146, 2019-07
Ovid Technologies (Wolters Kluwer Health)