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Research article
Minoru Oshima
Faculty of Medicine, Kagawa University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9114-7985
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Inflammatory nutritional factors, such as the neutrophil/lymphocyte ratio (NLR), Glasgow Prognostic Score (GPS), modified GPS (mGPS), and C-reactive protein/albumin (CRP/Alb) ratio, have prognostic values in many types of cancer. In this study, the prognostic values of inflammatory nutritional scores were evaluated in the patients with resectable or borderline resectable pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant chemoradiotherapy (NACRT).
Methods
A total of 49 patients who underwent pancreatectomy after NACRT from September 2009 to May 2016 were enrolled. The NACRT consisted of hypofractionated external-beam radiotherapy (30 Gy in 10 fractions) with concurrent S-1 (60 mg/m2) delivered 5 days/week for 2 weeks before pancreatectomy. Inflammatory nutritional scores were determined before and after NACRT in this series.
Results
The median NLR increased after NACRT (from 2.067 to 3.302), with statistical difference (p<0.001). In multivariate Cox regression analysis, high pre-NACRT mGPS (2 or 1; p=0.0478) and significant increase in CRP/Alb ratio after NACRT (≧0.077; p=0.0036) were associated with shorter overall survival. All patients were divided into two groups according to the ΔCRP/Alb ratio after NACRT: the group with high ΔCRP/Alb ratio (≧0.077) and the group with low ΔCRP/Alb ratio (<0.077). The group with high ΔCRP/Alb ratio after NACRT (n=13) not only had higher post-NACRT CRP levels (p<0.001) but also had lower post-NACRT Alb levels (p=0.002). Patients in the group with high ΔCRP/Alb ratio lost more body weight during NACRT (p=0.03).
Conclusion
In addition to pre-NACRT mGPS, ΔCRP/Alb after NACRT could provide prognostic value in the patients with PDAC treated by NACRT.
Keywords
inflammatory nutritional factor, PDAC, NACRT
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View the published article at BMC Gastroenterology.
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Editorial decision: Minor revision
On 29 Oct, 2020
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Received 21 Oct, 2020
Review #2 received
Received 21 Oct, 2020
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Received 20 Oct, 2020
Review #5 received
Received 15 Oct, 2020
Review #6 received
Received 15 Oct, 2020
Review #3 received
Received 12 Oct, 2020
Reviewer #6 agreed
On 12 Oct, 2020
Reviewer #7 agreed
On 12 Oct, 2020
Review #4 received
Received 12 Oct, 2020
Reviewer #5 agreed
On 11 Oct, 2020
Reviewer #4 agreed
On 10 Oct, 2020
Reviewer #2 agreed
On 09 Oct, 2020
Reviewer #3 agreed
On 09 Oct, 2020
Reviewer #1 agreed
On 01 Oct, 2020
Editor assigned
On 28 Sep, 2020
Reviewers invited
Invitations sent on 28 Sep, 2020
Submission checks complete
On 24 Sep, 2020
Editor invited
On 24 Sep, 2020
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Subject Areas
Gastroenterology & Hepatology
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Minoru Oshima
Faculty of Medicine, Kagawa University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9114-7985
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Gastroenterology.
Version 1
Posted 28 Sep, 2020
No community comments so far
Editorial decision: Minor revision
On 29 Oct, 2020
Review #1 received
Received 21 Oct, 2020
Review #2 received
Received 21 Oct, 2020
Review #7 received
Received 20 Oct, 2020
Review #5 received
Received 15 Oct, 2020
Review #6 received
Received 15 Oct, 2020
Review #3 received
Received 12 Oct, 2020
Reviewer #6 agreed
On 12 Oct, 2020
Reviewer #7 agreed
On 12 Oct, 2020
Review #4 received
Received 12 Oct, 2020
Reviewer #5 agreed
On 11 Oct, 2020
Reviewer #4 agreed
On 10 Oct, 2020
Reviewer #2 agreed
On 09 Oct, 2020
Reviewer #3 agreed
On 09 Oct, 2020
Reviewer #1 agreed
On 01 Oct, 2020
Editor assigned
On 28 Sep, 2020
Reviewers invited
Invitations sent on 28 Sep, 2020
Submission checks complete
On 24 Sep, 2020
Editor invited
On 24 Sep, 2020
First submitted
On 07 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Gastroenterology & Hepatology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Gastroenterology.
Background
Inflammatory nutritional factors, such as the neutrophil/lymphocyte ratio (NLR), Glasgow Prognostic Score (GPS), modified GPS (mGPS), and C-reactive protein/albumin (CRP/Alb) ratio, have prognostic values in many types of cancer. In this study, the prognostic values of inflammatory nutritional scores were evaluated in the patients with resectable or borderline resectable pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant chemoradiotherapy (NACRT).
Methods
A total of 49 patients who underwent pancreatectomy after NACRT from September 2009 to May 2016 were enrolled. The NACRT consisted of hypofractionated external-beam radiotherapy (30 Gy in 10 fractions) with concurrent S-1 (60 mg/m2) delivered 5 days/week for 2 weeks before pancreatectomy. Inflammatory nutritional scores were determined before and after NACRT in this series.
Results
The median NLR increased after NACRT (from 2.067 to 3.302), with statistical difference (p<0.001). In multivariate Cox regression analysis, high pre-NACRT mGPS (2 or 1; p=0.0478) and significant increase in CRP/Alb ratio after NACRT (≧0.077; p=0.0036) were associated with shorter overall survival. All patients were divided into two groups according to the ΔCRP/Alb ratio after NACRT: the group with high ΔCRP/Alb ratio (≧0.077) and the group with low ΔCRP/Alb ratio (<0.077). The group with high ΔCRP/Alb ratio after NACRT (n=13) not only had higher post-NACRT CRP levels (p<0.001) but also had lower post-NACRT Alb levels (p=0.002). Patients in the group with high ΔCRP/Alb ratio lost more body weight during NACRT (p=0.03).
Conclusion
In addition to pre-NACRT mGPS, ΔCRP/Alb after NACRT could provide prognostic value in the patients with PDAC treated by NACRT.
Figure 1
Figure 2
Figure 3
Figure 4
This is a list of supplementary files associated with this preprint. Click to download.
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