Pancreatic cancer – epidemiology, risk factors, nutritional and infl ammatory prognostic and predictive factors
Authors:
J. Homolová 1,2; D. Ondruš 2; M. Ondrušová 3,4; B. Bystrický 1; F. Kohútek 1; B. Mrinakova 2
Authors‘ workplace:
Onkologická klinika, Fakulta zdravotníctva, Trenčianska univerzita Alexandra Dubčeka a Fakultná nemocnica, Trenčín, Slovenská republika
1; I. onkologická klinika, Lekárska fakulta UK a Onkologický ústav sv. Alžbety, Bratislava, Slovenská republika
2; Katedra preventívnej a klinickej medicíny, Fakulta verejného zdravotníctva, Slovenská zdravotnícka univerzita, Bratislava, Slovenská republika
3; Oddelenie epidemiológie a štatistiky, Pharm-In, spol. s r. o., Bratislava, Slovenská republika
4
Published in:
Klin Onkol 2024; 38(4): 270-276
Category:
Original Articles
doi:
https://doi.org/10.48095/ccko2024270
Overview
Background: Pancreatic cancer remains one of the most challenging malignancies to treat, with consistently low survival rates despite advances in medical research. The identification and validation of effective prognostic biomarkers are crucial for improving diagnostic accuracy and treatment outcomes. Objective: The aim of the work is to analyze the latest data of the pancreatic cancer incidence and mortality, comparing them with global epidemiological data. The narrative review also aims to summarize current knowledge about various prognostic biomarkers in the pancreatic cancer treatment, including indicators of performance status, nutritional and inflammatory markers. Methods: The most recently available national epidemiological data on pancreatic cancer are analyzed. The literature review is focused on markers that evaluate the general condition of patients, such as performance status, body mass index, prognostic nutritional index and markers of the inflammatory response, such as Glasgow prognostic score, C-reactive protein, neutrophil to lymphocyte ratio, systemic inflammatory response index and systemic immune inflammation index. These biomarkers are analyzed for their role in predicting prognosis and response to systemic therapy for pancreatic cancer. Results: Both the Slovak Republic and the Czech Republic are globally ranked in the leading places in terms of pancreatic cancer incidence and mortality, both in estimates and real data. Indicators of nutritional and performance status play a critical role in patient assessment and influence treatment decisions, with potential impact on treatment outcomes. Inflammatory markers have shown significant prognostic value, correlating with the patient‘s immune response to the tumor and inflammatory processes that may promote disease progression. However, despite their promising predictive capabilities, these biomarkers are not routinely used in clinical practice due to the need for further validation. Conclusion: Integration of new biomarkers into clinical practice could lead to more personalized therapeutic decisions and improved treatment outcomes. Further research is needed for a more comprehensive assessment of the validity of these biomarkers and their use in common clinical conditions.
Keywords:
incidence – Pancreatic cancer – mortality – prognostic nutritional index – systemic inflammatory response index – systemic immune inflammation index – neutrophil to lymphocyte ratio
Sources
1. Kaušitz J, Ondruš D (eds.). Špeciálna onkológia. Bratislava: Solen 2020: 712.
2. World Cancer Research Fund International. Worldwide cancer data. [online]. Available from: https: //www.wcrf.org/cancer-trends/worldwide-cancer-data/.
3. Národné centrum zdravotníckych informácií SR. Incidencia zhubných nádorov v Slovenskej republike 2014. [online]. Dostupné z: https: //www.nczisk.sk/Statisticke_vystupy/Tematicke_statisticke_vystupy/Onkologia/Vystupy_NOR_SR/Pages/Incidencia-zhubnych-nadorov.aspx.
4. Národné centrum zdravotníckych informácií SR. Očakávaný počet novodiagnostikovaných zhubných nádorov v SR v rokoch 2017–2021. [online]. Dostupné z: https: //www.nczisk.sk/Statisticke_vystupy/Tematicke_statisticke_vystupy/Onkologia/Ocakavany_pocet_novodiagnostikovanych_zhubnych_nadorov_SR/Pages/ default.aspx.
5. Dušek L, Mužík J, Kubásek M et al. Epidemiologie zhoubných nádorů v České republike [online]. Dostupné z: http: //www.svod.cz.
6. Štatistický úrad SR: Zomrelí podľa príčiny smrti, veku, pohlavia a trvalého pobytu – SR, 2023. [online]. Dostupné z: https: //slovak.statistics.sk/wps/portal/ext/products/informationmessages/inf_sprava_detail.
7. Dell’aquila E, Fulgenzi Cam, Minelli A et al. Prognostic and predictive factors in pancreatic cancer. Oncotarget 2020; 11 (10): 924–941. doi: 10.18632/oncotarget.27518.
8. Karnofsky DA, Abelmann WH, Crave RL et al. The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma. Cancer 1948; 1 (4): 634–656.
9. Azam F, Latif MF, Farooq A et al. Performance status assessment by using ECOG (Eastern Cooperative Oncology Group) score for cancer patients by oncology healthcare professionals. Case Reports in Oncology 2019; 12 (3): 728–736. doi: 10.1159/000503095.
10. Le N, Sund M, Vinci A et al. Prognostic and predictive markers in pancreatic adenocarcinoma. Dig Liver Dis 2016; 48 (3): 223–230. doi: 10.1016/j.dld.2015.11.001.
11. Sezgin C, Karabulut B, Uslu R et al. Gemcitabine treatment in patients with inoperable locally advanced/metastatic pancreatic cancer and prognostic factors. Scand J Gastroenterol 2005; 40 (12): 1486–1492. doi: 10.1080/00365520510023819.
12. Tas F, Sen F, Odabas H et al. Performance status of patients is the major prognostic factor at all stages of pancreatic cancer. Int J Clin Oncol 2013; 18 (5): 839–846. doi: 10.1007/s10147-012-0474-9.
13. Bilici A. Prognostic factors related with survival in patients with pancreatic adenocarcinoma. World J Gastroenterol 2014; 20 (3): 10802–10812. doi: 10.3748/wjg.v20.i31.10802.
14. Li D, Morris JS, Liu J et al. Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA 2009; 301 (24): 2553–2562. doi: 10.1001/jama.2009.886.
15. Bracci PM. Obesity and pancreatic cancer: overview of epidemiologic evidence and biologic mechanisms. Mol Carcinog 2011; 51 (1): 53–63. doi: 10.1002/mc.20778.
16. Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nature Rev Cancer 2004; 4 (8): 579–591. doi: 10.1038/nrc1408.
17. Fleming JB, Gonzalez RJ, Petzel MQ et al. Influence of obesity on cancer-related outcomes after pancreatectomy to treat pancreatic adenocarcinoma. Arch Surg 2009; 144 (3): 216–221. doi: 10.1001/archsurg.2008.580.
18. Tsai S, Chot MA, Assumpcao L et al. Impact of obesity on perioperative outcomes and survival following pancreaticoduodenectomy for pancreatic cancer: A large single-institution study. J Gastrointest Surg 2010; 14 (7): 1143–1150. doi: 10.1007/s11605-010-1201-3.
19. Onodera T, Goseki N, Kosagi G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi 1984; 85 (9): 1001–1005.
20. Roganović B, Manojlović N, Perić et al. The usefulness of prognostic nutritional index in predicting infection in patients with newly diagnosed pancreatic cancer. Biomed J Sci & Tech Res, 2021; 34 (2): 26589–26595.
21. Kim KH, Hwang HG, Kang IC et al. Oncologic impact of preoperative prognostic nutritional index change in resected pancreatic cancer following neoadjuvant chemotherapy. Pancreatology 2020; 20 (2): 247–253. doi: 10.1016/j.pan.2019.12.006.
22. Sagawa M, Yokomizo H, Yoshimatsu K et al. The influence of immunity, nutrition, and physical function on the onset of pneumonia after colorectal cancer resection. Gan To Kagaku Ryoho 2018; 45 (10): 1486–1488.
23. Sun K, Chen S, Xu J et al. The prognostic significance of the prognostic nutritional index in cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2014; 140 (9): 1537–1549. doi: 10.1007/s00432-014-1714-3.
24. Rungsakulkij N, Tangtawee P, Suragul W et al. Correlation of serum albumin and prognostic nutritional index with outcomes following pancreaticoduodenectomy. World J Clin Cases 2019; 7 (1): 28–38. doi: 10.12998/wjcc.v7.i1.28.
25. Aoyama T, Maezawa Y, Hashimoto I et al. Clinical impact of nutrition and inflammation assessment tools in pancreatic cancer treatment. Anticancer Res 2023; 43 (9): 3849–3860. doi: 10.21873/anticanres.16572.
26. Jamieson NB, Mohamed M, Oien KA et al. The relationship between tumor inflammatory cell infiltrate and outcome in patients with pancreatic ductal adenocarcinoma. Ann Surg Oncol, 2012; 19 (11): 3581–3590. doi: 10.1245/s10434-012-2370-y.
27. Szkandera J, Stotz M, Absenger M et al. Validation of C-reactive protein levels as a prognostic indicator for survival in a large cohort of pancreatic cancer patients. Br J Cancer 2013; 110 (1): 183–188. doi: 10.1038/bjc. 2013.701.
28. Bonazzi VF, Aoude LG, Brosda S et al. C-reactive protein is a prognostic biomarker in pancreatic ductal adenocarcinoma patients. Asia Pac J Clin Oncol 2023. [In press]. doi: 10.1111/ajco. 13993.
29. Falconer JS, Fearon KC, Ross JA et al. Acute-phase protein response and survival duration of patients with pancreatic cancer. Cancer 1995; 75 (8): 2077–2082. doi: 10.1002/1097-0142 (19950415) 75: 8<2077:: aid-cncr2820 750808>3.0.co; 2-9.
30. Ueno H, Okada S, Okusaka T et al. Prognostic factors in patients with metastatic pancreatic adenocarcinoma receiving systemic chemotherapy. Oncology 2000; 59 (4): 296–301. doi: 10.1159/000012186.
31. Jamieson NB, Glen P, Mcmillan DC et al. Systemic inflammatory response predicts outcome in patients undergoing resection for ductal adenocarcinoma head of pancreas. Br J Cancer 2004; 92 (1): 21–23. doi: 10.1038/sj.bjc.6602305.
32. Papadoniou N, Kosmas CH, Gennatas K et al. Prognostic factors in patients with locally advanced (unresectable) or metastatic pancreatic adenocarcinoma: a retrospective analysis. Anticancer Res 2008; 28 (1B): 543–549. doi: 10.1038/sj.bjc.6602305.
33. Sanjay P, De Figueiredo RS, Leaver H et al. Preoperative serum C-reactive protein levels and postoperative lymph node ratio are important predictors of survival after pancreaticoduodenectomy for ductal adenocarcinoma. JOP 2012; 13 (2): 199–204.
34. Garcea G, Ladwa N, Neal CP et al. Preoperative neutrophil-to-lymphocyte ratio (NLR) is associated with reduced disease-free survival following curative resection of pancreatic adenocarcinoma. World J Surg 2011; 35 (4): 868–872. doi: 10.1007/s00268-011-0984-z.
35. Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratislavske Lekarske Listy 2021; 122 (7): 474–488. doi: 10.4149/BLL_2021_078.
36. Walsh SR, Cook EJ, Goulder F et al. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal rancer. J Surg Oncol 2021; 91 (3): 181–184. doi: 10.1002/jso.20329.
37. Yang JJ, Hu ZG, Shi WX et al. Prognostic significance of neutrophil to lymphocyte ratio in pancreatic cancer: a meta-analysis. World J Gastroenterol 2015; 21 (9): 2807–2815. doi: 10.3748/wjg.v21.i9.2807.
38. Ventriglia J, Petrillo A, Huera AM et al. Neutrophil to lymphocyte ratio as a predictor of poor prognosis in metastatic pancreatic cancer patients treated with nab-paclitaxel plus gemcitabine: a propensity score analysis. Gastroenterol Res Pract 2018; 2373868. doi: 10.1155/2018/2373868.
39. Xiang ZJ, Hu T, Wang Y et al. Neutrophil–lymphocyte ratio (NLR) was associated with prognosis and immunomodulatory in patients with pancreatic ductal adenocarcinoma (PDAC). Biosci Rep 2020; 40 (6): BSR20201190. doi: 10.1042/BSR20201190.
40. Nora I, Shridhar R, Huston J et al. The accuracy of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as a marker for gastrointestinal malignancies. J Gastrointest Oncol 2018; 9 (5): 972–978. doi: 10.21037/jgo.2018.08.05.
41. Ponter D Jr, Roife D, Powers BD et al. Neutrophil to lymphocyte ratio, not platelet to lymphocyte or lymphocyte to monocyte ratio, is predictive of patient survival after resection of early-stage pancreatic ductal adenocarcinoma. BMC Cancer 2020; 20 (1): 750. doi: 10.1186/s12885-020-07182-9.
42. Chawla A, Huang TL, Ibrahim AM et al. Pretherapy neutrophil to lymphocyte ratio and platelet to lymphocyte ratio do not predict survival in resectable pancreatic cancer. HPB 2024; 20 (5): 398–404. doi: 10.1016/j.hpb.2017.10.011.
43. Jamieson NB, Denley SM, Logue J et al. A prospective comparison of the prognostic value of tumor- and patient-related factors in patients undergoing potentially curative surgery for pancreatic ductal adenocarcinoma. Ann Surg Oncol 2011; 18 (8): 2318–2328. doi: 10.1245/s10434-011-1560-3.
44. Qi Q, Zhuang L, Shen Y et al. A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy. Cancer 2016; 122 (14): 2158–2167. doi: 10.1002/cncr. 30057.
45. Pacheco-Barcia V, Mondéjar SR, France T et al. A systemic inflammation response index (SIRI) correlates with survival and predicts oncological outcome for mFOLFIRINOX therapy in metastatic pancreatic cancer. Pancreatology 2020; 20 (2): 254–264. doi: 10.1016/j.pan. 2019.12.010.
46. Li X, Lin H, Ouyang R et al. Prognostic significance of the systemic immune inflammation index in pancreatic carcinoma patients: a meta-analysis. Bioscience Reports 2021; 41 (8): BSR20204401. doi: 10.1042/BSR20204401.
47. Murthy P, Zenati MS, Al AA et al. Prognostic value of the systemic immune-inflammation Index (SII) after neoadjuvant therapy for patients with resected pancreatic cancer. Ann Surg Oncol 2019; 27 (3): 898–906. doi: 10.1245/s10434-019-08094-0.
Labels
Paediatric clinical oncology Surgery Clinical oncologyArticle was published in
Clinical Oncology
2024 Issue 4
Most read in this issue
- The guidelines for clinical practice for carriers of germline mutations in hereditary breast, ovarian, prostate, and pancreatic cancer predisposition genes BRCA1, BRCA2, PALB2, ATM, and CHEK2 (4.2024)
- Pancreatic cancer – epidemiology, risk factors, nutritional and infl ammatory prognostic and predictive factors
- Staging for endometrial carcinoma FIGO 2023 and its relevance for clinical practice
- Aktuální indikace neoadjuvantní a adjuvantní imunoterapie v léčbě nemalobuněčného karcinomu plic