Abstract
Background: Identifying pre-treatment blood markers that distinguish prognostic groups of patients with advanced pancreatic ductal adenocarcinoma (PDAC) under first-line FOLFIRINOX chemotherapy has the potential to improve management of this condition. Aim of this study was to determine the prognostic utility of a range of pre-treatment, inflammation related, blood cell markers in this group of patients.
Materials and Methods: Data from a training cohort were analyzed to identify potential pre-treatment blood markers correlating to survival outcomes. The most informative markers were further analyzed in a validation cohort comprised of patients from a geographically separate cancer center undergoing the same treatment.
Results: 138 consecutive patients receiving FOLFIRINOX chemotherapy between 2010 & 2019, constituted the training cohort. Neutrophil/lymphocyte (NLR), monocyte/lymphocyte (MLR) and platelet/lymphocyte ratio (PLR) as well as the systemic inflammatory response index (SIRI) and CA19.9 showed prognostic significance in addition to tumour stage. A pre-treatment SIRI score cutoff of 2.35 differentiated between a poor prognostic group with median overall survival (mOS) 5.1 months and a better prognostic group, mOS 12.5 months. SIRI / > 2.35 was predictive of mOS in patients with locally advanced and metastatic PDAC. SIRI was confirmed as a prognostic marker in a validation cohort of 67 patients with mOS of 13.4 months and 6.3 months for those with SIRI 2.35 and >2.35 respectively. Additional analysis revealed baseline SIRI as being prognostic within additional subgroups of patients in both cohorts.
Conclusion: This large, retrospective, analysis of real world patients receiving first-line FOLFIRINOX chemotherapy for advanced PDAC has identified the pre-treatment blood SIRI as a strong prognostic marker for survival. This will allow better counselling of patients with regards to the benefits of treatment, improved stratification within clinical trials and potentially identify groups of patients for novel therapy trials as first line treatment.
Materials and Methods: Data from a training cohort were analyzed to identify potential pre-treatment blood markers correlating to survival outcomes. The most informative markers were further analyzed in a validation cohort comprised of patients from a geographically separate cancer center undergoing the same treatment.
Results: 138 consecutive patients receiving FOLFIRINOX chemotherapy between 2010 & 2019, constituted the training cohort. Neutrophil/lymphocyte (NLR), monocyte/lymphocyte (MLR) and platelet/lymphocyte ratio (PLR) as well as the systemic inflammatory response index (SIRI) and CA19.9 showed prognostic significance in addition to tumour stage. A pre-treatment SIRI score cutoff of 2.35 differentiated between a poor prognostic group with median overall survival (mOS) 5.1 months and a better prognostic group, mOS 12.5 months. SIRI / > 2.35 was predictive of mOS in patients with locally advanced and metastatic PDAC. SIRI was confirmed as a prognostic marker in a validation cohort of 67 patients with mOS of 13.4 months and 6.3 months for those with SIRI 2.35 and >2.35 respectively. Additional analysis revealed baseline SIRI as being prognostic within additional subgroups of patients in both cohorts.
Conclusion: This large, retrospective, analysis of real world patients receiving first-line FOLFIRINOX chemotherapy for advanced PDAC has identified the pre-treatment blood SIRI as a strong prognostic marker for survival. This will allow better counselling of patients with regards to the benefits of treatment, improved stratification within clinical trials and potentially identify groups of patients for novel therapy trials as first line treatment.
| Original language | English |
|---|---|
| Journal | Acta Oncologica |
| Publication status | Accepted/In press - 11 Mar 2022 |
Research Beacons, Institutes and Platforms
- Manchester Cancer Research Centre
