Establishment and application of a preoperative grading system for resectable pancreatic cancer

Chengfang WANG; Zhijiang WANG; Weilin WANG

doi:10.3969/j.issn.1001-5256.2022.10.023

Volume 38 Issue 10

Oct. 2022

Turn off MathJax

Article Contents

Article Navigation > Journal of Clinical Hepatology > 2022 > 38(10): 2325-2333

PDF( 2058 KB)

Establishment and application of a preoperative grading system for resectable pancreatic cancer

DOI: 10.3969/j.issn.1001-5256.2022.10.023

Chengfang WANG¹,
Zhijiang WANG¹,
Weilin WANG^{1, 2, 3, 4, 5
,
,
,}

1.
Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
2.
Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, China
3.
Zhejiang Provincial Research Center for Diagnosis and Treatment of Liver Cancer, Hangzhou 310009, China
4.
Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Diseases, Zhejiang University, Hangzhou 310009, China
5.
Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou 310009, China

Research funding:

National Natural Science Foundation of China (81773096);

National Natural Science Foundation of China (82072650)

More Information

Corresponding author: WANG Weilin, wam@zju.edu.cn(ORCID: 0000-0001-9432-2649)
Received Date: 2022-02-23
Accepted Date: 2022-03-29
Published Date: 2022-10-20

Abstract

Abstract

Objective To investigate the risk factors for early recurrence of resectable pancreatic cancer and the establishment and application of a grading system. Methods A retrospective case-control study was conducted among 303 patients with resectable pancreatic cancer who underwent radical resection in Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, from March 2015 to June 2021, and according to the presence or absence of early recurrence (within 6 months after surgery), the 283 patients directly operated on were divided into early recurrence group with 95 patients and non-early recurrence group with 188 patients; 20 patients who received neoadjuvant therapy before surgery were enrolled as neoadjuvant therapy group. Observation indicators included general information, preoperative imaging data, preoperative laboratory data, routine blood test/blood biochemistry and derived indicators, tumor markers, and coagulation markers, and follow-up was conducted to observe recurrence-free survival. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A multivariate Logistic regression analysis was used to investigate the risk factors for early recurrence in patients with pancreatic cancer, and the receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of each indicator. The Kaplan-Meier curve was plotted, and the Log-rank test was used for comparison of recurrence-free survival time between groups. Results The univariate analysis showed that compared with the non-early recurrence group, the early recurrence group had significantly lower body mass index (BMI) and triglyceride and significantly higher CA19-9, CA242, CA125, and plasma fibrinogen (all P < 0.05). The multivariate logistic regression analysis showed that BMI (odds ratio [OR]=1.150, 95% confidence interval [CI]: 1.038-1.273, P=0.007), plasma fibrinogen (OR=2.513, 95%CI: 1.355-4.663, P=0.003), and CA242 (OR=2.482, 95%CI: 1.067-5.774, P=0.035) were independent risk factors for early recurrence in patients with resectable pancreatic cancer. BMI, CA242, and plasma fibrinogen were included in the grading system, with a cut-off value of 23.00 kg/m², 30.0 U/mL, and 4.00 g/L, respectively. BMI < 23.00 kg/m² was counted as 1 point, otherwise it was counted as 0 point; CA242≥30.00 U/mL was counted as 1 point, otherwise it was counted as 0 point; plasma fibrinogen ≥4.00 g/L was counted as 1 point, otherwise it was counted as 0 point; the total score was 0-3 points. The patients in both the early recurrence group and the non-early recurrence group were scored, and the results showed that the early recurrence group had a significantly higher score than the non-early recurrence group [2(0-3) points vs 1(0-3) point, Z=-5.339, P < 0.001]. The Kaplan-Meier curve analysis showed that there was a significant difference in time to recurrence between groups (χ²=28.116, P < 0.001), and the higher the score, the shorter the expected time to recurrence. The patients with 3 points were defined as high-risk group and those with 0-2 points were defined as low-risk group, and the early recurrence rate was 84.6% in the high-risk group and 31.2% in the low-risk group. Conclusion The grading system based on BMI, plasma fibrinogen, and CA242 can reliably predict postoperative recurrence.
- Pancreatic Neoplasms,
- Neoplasm Recurrence, Local,
- Risk Factors

FullText(HTML)

References(37)

References

[1]	SIEGEL RL, MILLER KD, FUCHS HE, et al. Cancer statistics, 2021[J]. CA Cancer J Clin, 2021, 71(1): 7-33. DOI: 10.3322/caac.21654.
[2]	CHEN X, YI B, LIU Z, et al. Global, regional and national burden of pancreatic cancer, 1990 to 2017: Results from the Global Burden of Disease Study 2017[J]. Pancreatology, 2020, 20(3): 462-469. DOI: 10.1016/j.pan.2020.02.011.
[3]	ZHANG QH, NI QX, Coordination Group of The Committee on Pancreatic Cancer. Clinical analysis of 2340 cases of pancreatic cancer[J]. Natl Med J China, 2004, 84(3): 214-218. DOI: 10.3760/j:issn:0376-2491.2004.03.010. 张群华, 倪泉兴, 中国抗癌协会胰腺癌专业委员会. 胰腺癌2340例临床病例分析[J]. 中华医学杂志, 2004, 84(3): 214-218. DOI: 10.3760/j:issn:0376-2491.2004.03.010.
[4]	GROOT VP, DAAMEN LA, HAGENDOORN J, et al. Current strategies for detection and treatment of recurrence of pancreatic ductal adenocarcinoma after resection: A nationwide survey[J]. Pancreas, 2017, 46(9): e73-e75. DOI: 10.1097/MPA.0000000000000899.
[5]	NEOPTOLEMOS JP, PALMER DH, GHANEH P, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial[J]. Lancet, 2017, 389(10073): 1011-1024. DOI: 10.1016/S0140-6736(16)32409-6.
[6]	CONROY T, HAMMEL P, HEBBAR M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer[J]. N Engl J Med, 2018, 379(25): 2395-2406. DOI: 10.1056/NEJMoa1809775.
[7]	GROOT VP, GEMENETZIS G, BLAIR AB, et al. Defining and predicting early recurrence in 957 patients with resected pancreatic ductal adenocarcinoma[J]. Ann Surg, 2019, 269(6): 1154-1162. DOI: 10.1097/SLA.0000000000002734.
[8]	TEMPERO MA, MALAFA MP, AL-HAWARY M, et al. Pancreatic adenocarcinoma, Version 2.2021, NCCN Clinical Practice Guidelines in oncology[J]. J Natl Compr Canc Netw, 2021, 19(4): 439-457. DOI: 10.6004/jnccn.2021.0017.
[9]	Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association. Guidelines for the diagnosis and treatment of pancreatic cancer in China (2021)[J]. Chin J Pract Surg, 2021, 41(7): 725-738. DOI: 10.19538/j.cjps.issn1005-2208.2021.07.02. 中华医学会外科学分会胰腺外科学组. 中国胰腺癌诊治指南(2021)[J]. 中国实用外科杂志, 2021, 41(7): 725-738. DOI: 10.19538/j.cjps.issn1005-2208.2021.07.02.
[10]	SUR YK, KIM YC, KIM JK, et al. Comparison of ultrasound-guided core needle biopsy and endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesions[J]. J Ultrasound Med, 2015, 34(12): 2163-2169. DOI: 10.7863/ultra.14.11030.
[11]	SOHN TA, YEO CJ, CAMERON JL, et al. Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators[J]. J Gastrointest Surg, 2000, 4(6): 567-579. DOI: 10.1016/s1091-255x(00)80105-5.
[12]	WAGNER M, REDAELLI C, LIETZ M, et al. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma[J]. Br J Surg, 2004, 91(5): 586-594. DOI: 10.1002/bjs.4484.
[13]	HAENO H, GONEN M, DAVIS MB, et al. Computational modeling of pancreatic cancer reveals kinetics of metastasis suggesting optimum treatment strategies[J]. Cell, 2012, 148(1-2): 362-375. DOI: 10.1016/j.cell.2011.11.060.
[14]	ZHENG MH, SHAO CH. Evaluation of neoadjuvant chemotherapy for pancreatic cancer and timing of surgery[J/CD]. Chin J Hepat Surg: Electronic Edition, 2020, 9(5): 418-420. DOI: 10.3877/cma.j.issn.2095-3232.2020.05.005. 郑明辉, 邵成浩. 胰腺癌新辅助化疗疗效评估及手术时机[J/CD]. 中华肝脏外科手术学电子杂志, 2020, 9(5): 418-420. DOI: 10.3877/cma.j.issn.2095-3232.2020.05.005.
[15]	YANG YM, ZHAO XD. Evaluation of neoadjuvant therapy for pancreatic cancer: is it the best choice?[J]. Chin J Dig Surg, 2020, 19(1): 41-45. DOI: 10.3760/cma.j.issn.1673-9752.2020.01.006. 杨尹默, 赵旭东. 肯定还是否定: 胰腺癌新辅助治疗[J]. 中华消化外科杂志, 2020, 19(1): 41-45. DOI: 10.3760/cma.j.issn.1673-9752.2020.01.006.
[16]	KURAHARA H, MAEMURA K, MATAKI Y, et al. A Therapeutic strategy for resectable pancreatic cancer based on risk factors of early recurrence[J]. Pancreas, 2018, 47(6): 753-758. DOI: 10.1097/MPA.0000000000001066.
[17]	IMAMURA M, NAGAYAMA M, KYUNO D, et al. Perioperative predictors of early recurrence for resectable and borderline-resectable pancreatic cancer[J]. Cancers (Basel), 2021, 13(10): 2285. DOI: 10.3390/cancers13102285.
[18]	HANK T, HINZ U, REINER T, et al. A pretreatment prognostic score to stratify survival in pancreatic cancer[J]. Ann Surg, 2021. DOI: 10.1097/SLA.0000000000004845. [Online ahead of print]
[19]	KIM DW, LEE SS, KIM SO, et al. Estimating recurrence after upfront surgery in patients with resectable pancreatic ductal adenocarcinoma by using pancreatic CT: Development and validation of a risk score[J]. Radiology, 2020, 296(3): 541-551. DOI: 10.1148/radiol.2020200281.
[20]	OKABAYASHI T, SHIMA Y, SUMIYOSHI T, et al. A novel physiobiological parameter-based grading system for resectable pancreatic cancer[J]. Ann Surg Oncol, 2018, 25(7): 1889-1895. DOI: 10.1245/s10434-018-6485-7.
[21]	HOSHIMOTO S, HISHINUMA S, SHIRAKAWA H, et al. Validation and clinical usefulness of pre- and postoperative systemic inflammatory parameters as prognostic markers in patients with potentially resectable pancreatic cancer[J]. Pancreatology, 2020, 20(2): 239-246. DOI: 10.1016/j.pan.2019.12.004.
[22]	YAMADA S, FUJII T, YABUSAKI N, et al. Clinical implication of infammation-based prognostic score in pancreatic cancer: Glasgow prognostic score is the most reliable parameter[J]. Medicine (Baltimore), 2016, 95(18): e3582. DOI: 10.1097/MD.0000000000003582.
[23]	LIU Z, JIN K, GUO M, et al. Prognostic value of the CRP/Alb ratio, a novel inflammation-based score in pancreatic cancer[J]. Ann Surg Oncol, 2017, 24(2): 561-568. DOI: 10.1245/s10434-016-5579-3.
[24]	KANDA M, FUJII T, KODERA Y, et al. Nutritional predictors of postoperative outcome in pancreatic cancer[J]. Br J Surg, 2011, 98(2): 268-274. DOI: 10.1002/bjs.7305.
[25]	STOTZ M, GERGER A, EISNER F, et al. Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer[J]. Br J Cancer, 2013, 109(2): 416-421. DOI: 10.1038/bjc.2013.332.
[26]	BHATTI I, PEACOCK O, LLOYD G, et al. Preoperative hematologic markers as independent predictors of prognosis in resected pancreatic ductal adenocarcinoma: neutrophil-lymphocyte versus platelet-lymphocyte ratio[J]. Am J Surg, 2010, 200(2): 197-203. DOI: 10.1016/j.amjsurg.2009.08.041.
[27]	CHENG Y, LI LX, ZENG WB. Prediction of combination detection of serum CEA, CA19-9 and CA50 levels for surgical resectability of pancreatic cancer[J]. Clin Misdiagn Misther, 2020, 33(1): 84-87. DOI: 10.3969/j.issn.1002-3429.2020.01.020. 程勇, 李领侠, 曾文斌. 血清CEA、CA19-9、CA50联合检测对胰腺癌手术可切除性的预测价值研究[J]. 临床误诊误治, 2020, 33(1): 84-87. DOI: 10.3969/j.issn.1002-3429.2020.01.020.
[28]	LUO G, LIU C, GUO M, et al. Potential biomarkers in lewis negative patients with pancreatic cancer[J]. Ann Surg, 2017, 265(4): 800-805. DOI: 10.1097/SLA.0000000000001741.
[29]	LIU L, XU H, WANG W, et al. A preoperative serum signature of CEA⁺/CA125⁺/CA19-9≥1000 U/mL indicates poor outcome to pancreatectomy for pancreatic cancer[J]. Int J Cancer, 2015, 136(9): 2216-2227. DOI: 10.1002/ijc.29242.
[30]	VYAS SJ, PURI YS, JOHN BJ, et al. Radiological tumor density and lymph node size correlate with survival in resectable adenocarcinoma of the pancreatic head: A retrospective cohort study[J]. J Cancer Res Ther, 2016, 12(1): 417-421. DOI: 10.4103/0973-1482.171358.
[31]	STRIJKER M, van der SIJDE F, SUKER M, et al. Preoperative serum ADAM12 levels as a stromal marker for overall survival and benefit of adjuvant therapy in patients with resected pancreatic and periampullary cancer[J]. HPB (Oxford), 2021, 23(12): 1886-1896. DOI: 10.1016/j.hpb.2021.05.001.
[32]	Early Diagnosis and Treatment Group, the Oncology Committee of Chinese Medical Association. Expert consensus of Oncology Committee of Chinese Medical Association in early diagnosis and treatment of pancreatic cancer[J]. J Clin Hepatol, 2020, 36(12): 2675-2680. DOI: 10.3969/j.issn.1001-5256.2020.12.008. 中华医学会肿瘤学分会早诊早治学组. 中华医学会肿瘤学分会胰腺癌早诊早治专家共识[J]. 临床肝胆病杂志, 2020, 36(12): 2675-2680. DOI: 10.3969/j.issn.1001-5256.2020.12.008.
[33]	HISADA Y, MACKMAN N. Cancer-associated pathways and biomarkers of venous thrombosis[J]. Blood, 2017, 130(13): 1499-1506. DOI: 10.1182/blood-2017-03-743211.
[34]	SGOUROS J, MARAVEYAS A. Excess premature (3-month) mortality in advanced pancreatic cancer could be related to fatal vascular thromboembolic events. A hypothesis based on a systematic review of phase III chemotherapy studies in advanced pancreatic cancer[J]. Acta Oncol, 2008, 47(3): 337-346. DOI: 10.1080/02841860701687267.
[35]	CAO J, FU Z, GAO L, et al. Evaluation of serum D-dimer, fibrinogen, and CA19-9 for postoperative monitoring and survival prediction in resectable pancreatic carcinoma[J]. World J Surg Oncol, 2017, 15(1): 48. DOI: 10.1186/s12957-017-1104-9.
[36]	ARAKAWA Y, MIYAZAKI K, YOSHIKAWA M, et al. Value of the fibrinogen-platelet ratio in patients with resectable pancreatic cancer[J]. J Med Invest, 2021, 68(3.4): 342-346. DOI: 10.2152/jmi.68.342.
[37]	DREYER SB, PINESE M, JAMIESON NB, et al. Precision oncology in surgery: Patient selection for operable pancreatic cancer[J]. Ann Surg, 2020, 272(2): 366-376. DOI: 10.1097/SLA.0000000000003143.

Relative Articles

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Figures(1) / Tables(6)

Get Citation

PDF

XML

Article Metrics

Article views (307) PDF downloads(47)

Establishment and application of a preoperative grading system for resectable pancreatic cancer

DOI: 10.3969/j.issn.1001-5256.2022.10.023

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Establishment and application of a preoperative grading system for resectable pancreatic cancer

DOI: 10.3969/j.issn.1001-5256.2022.10.023

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

About Journal

Submission Guideline

Journal Online

Hepatobiliary College

Guidelines

Export File

Citation

Format

Content