Systemic inflammatory prognostic scores in advanced pancreatic adenocarcinoma
Menée à partir d'échantillons biopsiques prélevés sur 263 patients atteints d'un adénocarcinome pancréatique de stade avancé, cette étude compare la performance de cinq systèmes de score, basés sur des indicateurs de l'inflammation (rapport neutrophiles/lymphocytes, rapport plaquettes/lymphocytes, niveau sérique de l'albumine et de la lactate déshydrogénase), pour établir un pronostic
Background : Systemic inflammatory scores may aid prognostication and patient selection for trials. We compared five scores in advanced pancreatic adenocarcinoma (PDAC).
Methods : Unresectable/metastatic PDAC patients enrolled in the Comprehensive Molecular Characterisation of Advanced Pancreatic Ductal Adenocarcinoma for Better Treatment Selection trial (NCT02750657) were included. Patients had pre-treatment biopsies for whole genome and RNA sequencing. CD8 immunohistochemistry was available in a subset. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, Prognostic Nutritional Index, Gustave Roussy Immune Score (GRIm-S), and Memorial Sloan Kettering Prognostic Score (MPS) were calculated. Overall survival (OS) was estimated using Kaplan–Meier methods. Associations between inflammatory scores, clinical/genomic characteristics, and OS were analysed.
Results : We analysed 263 patients. High-risk NLR, GRIm-S and MPS were poorly prognostic. The GRIm-S had the highest predictive ability: median OS 6.4 vs. 10 months for high risk vs. low-risk (P < 0.001); HR 2.26 (P < 0.001). ECOG
≥
1, the basal-like subtype, and low-HRDetect were additional poor prognostic factors (P < 0.01). Inflammatory scores did not associate with RNA-based classifiers or homologous recombination repair deficiency genotypes. High-risk MPS (P = 0.04) and GRIm-S (P = 0.02) patients had lower median CD8 + tumour-infiltrating lymphocytes.
Conclusions : Inflammatory scores incorporating NLR have prognostic value in advanced PDAC. Understanding immunophenotypes of poor-risk patients and using these scores in trials will advance the field.
British Journal of Cancer , résumé, 2023