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Research article
Nils Elander
Linkopings universitet
Corresponding Author
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Background: In recent years treatment options for advanced pancreatic cancer has markedly improved, and a combination regimen of gemcitabine and nab-paclitaxel is now considered standard of care in Sweden and elsewhere. Nevertheless, a majority of patients do not respond to treatment. In order to guide the individual patient to the most beneficial therapeutic strategy, simple and easily available prognostic and predictive markers are needed.
Methods: The potential prognostic value of a range of blood/serum parameters, patient-, and tumour characteristics was explored in a retrospective cohort of 75 patients treated with gemcitabine/nab-paclitaxel (Gem/NabP) for advanced pancreatic ductal adenocarcinoma (PDAC) in the South Eastern Region of Sweden. Primary outcome was overall survival while progression free survival was the key secondary outcome.
Result: Univariable Cox regression analysis revealed that high baseline serum albumin (> 37 g/L) and older age (>65) were positive prognostic markers for OS, and in multivariable regression analysis both parameters were confirmed to be independent prognostic variables (HR 0.48, p=0.023 and HR=0.47, p=0.039,). Thrombocytopenia at any time during the treatment was an independent predictor for improved progression free survival (PFS) but not for OS (HR 0.49, p=0.029, 0.54, p=0.073), whereas thrombocytopenia developed under cycle 1 was neither related with OS nor PFS (HR 0.87, p=0.384, HR 1.04, p=0.771). Other parameters assessed (gender, tumour stage, ECOG performance status, myelosuppression, baseline serum CA19-9, and baseline serum bilirubin levels) were not significantly associated with survival.
Conclusion: Serum albumin at baseline is a prognostic factor with palliative Gem/NabP in advanced PDAC, and should be further assessed as a tool for risk stratification. Older age was associated with improved survival, which encourages further studies on the use of Gem/NabP in the elderly.
Keywords
Pancreatic cancer, gemcitabine, nab-paclitaxel, prognostic markers, serum albumin
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CURRENT STATUS: Published
View the published article at BMC Cancer.
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Posted 18 Sep, 2020
No community comments so far
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On 17 Sep, 2020
Editorial decision: Accept
On 16 Sep, 2020
No comments provided
Editor assigned
On 13 Aug, 2020
Submission checks complete
On 12 Aug, 2020
Editor invited
On 12 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 03 Aug, 2020
Review #2 received
Received 31 Jul, 2020
Reviewer #2 agreed
On 15 Jul, 2020
Review #1 received
Received 08 Mar, 2020
Reviewer #1 agreed
On 02 Mar, 2020
Reviewers invited
Invitations sent on 02 Mar, 2020
Editor assigned
On 28 Jan, 2020
Submission checks complete
On 27 Jan, 2020
Editor invited
On 27 Jan, 2020
No comments provided
Review #1 received
Received 13 Jan, 2020
Editorial decision: Major revision
On 13 Jan, 2020
Review #2 received
Received 11 Jan, 2020
Reviewer #2 agreed
On 01 Jan, 2020
Reviewer #1 agreed
On 26 Dec, 2019
Reviewers invited
Invitations sent on 24 Dec, 2019
Editor assigned
On 12 Dec, 2019
Submission checks complete
On 10 Dec, 2019
Editor invited
On 09 Dec, 2019
First submitted
On 02 Dec, 2019
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See the published version of this preprint at BMC Cancer.
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
Nils Elander
Linkopings universitet
Corresponding Author
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 Cancer.
Version 4
Posted 18 Sep, 2020
No community comments so far
Submission checks complete
On 17 Sep, 2020
Editorial decision: Accept
On 16 Sep, 2020
No comments provided
Editor assigned
On 13 Aug, 2020
Submission checks complete
On 12 Aug, 2020
Editor invited
On 12 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 03 Aug, 2020
Review #2 received
Received 31 Jul, 2020
Reviewer #2 agreed
On 15 Jul, 2020
Review #1 received
Received 08 Mar, 2020
Reviewer #1 agreed
On 02 Mar, 2020
Reviewers invited
Invitations sent on 02 Mar, 2020
Editor assigned
On 28 Jan, 2020
Submission checks complete
On 27 Jan, 2020
Editor invited
On 27 Jan, 2020
No comments provided
Review #1 received
Received 13 Jan, 2020
Editorial decision: Major revision
On 13 Jan, 2020
Review #2 received
Received 11 Jan, 2020
Reviewer #2 agreed
On 01 Jan, 2020
Reviewer #1 agreed
On 26 Dec, 2019
Reviewers invited
Invitations sent on 24 Dec, 2019
Editor assigned
On 12 Dec, 2019
Submission checks complete
On 10 Dec, 2019
Editor invited
On 09 Dec, 2019
First submitted
On 02 Dec, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Cancer.
Background: In recent years treatment options for advanced pancreatic cancer has markedly improved, and a combination regimen of gemcitabine and nab-paclitaxel is now considered standard of care in Sweden and elsewhere. Nevertheless, a majority of patients do not respond to treatment. In order to guide the individual patient to the most beneficial therapeutic strategy, simple and easily available prognostic and predictive markers are needed.
Methods: The potential prognostic value of a range of blood/serum parameters, patient-, and tumour characteristics was explored in a retrospective cohort of 75 patients treated with gemcitabine/nab-paclitaxel (Gem/NabP) for advanced pancreatic ductal adenocarcinoma (PDAC) in the South Eastern Region of Sweden. Primary outcome was overall survival while progression free survival was the key secondary outcome.
Result: Univariable Cox regression analysis revealed that high baseline serum albumin (> 37 g/L) and older age (>65) were positive prognostic markers for OS, and in multivariable regression analysis both parameters were confirmed to be independent prognostic variables (HR 0.48, p=0.023 and HR=0.47, p=0.039,). Thrombocytopenia at any time during the treatment was an independent predictor for improved progression free survival (PFS) but not for OS (HR 0.49, p=0.029, 0.54, p=0.073), whereas thrombocytopenia developed under cycle 1 was neither related with OS nor PFS (HR 0.87, p=0.384, HR 1.04, p=0.771). Other parameters assessed (gender, tumour stage, ECOG performance status, myelosuppression, baseline serum CA19-9, and baseline serum bilirubin levels) were not significantly associated with survival.
Conclusion: Serum albumin at baseline is a prognostic factor with palliative Gem/NabP in advanced PDAC, and should be further assessed as a tool for risk stratification. Older age was associated with improved survival, which encourages further studies on the use of Gem/NabP in the elderly.
Figure 1
Figure 2
Figure 3
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