Hematological Indices of Distant Metastases and Prognostic Nomogram in Gastro-Pancreatic and Biliary Tract Cancers

Abstract

Razan Mansour,1 Osama Abu-Shawer,2 Ali Lattouf,3 Hala Sultan,3 Maysa Al-Hussaini4 1Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan; 2Department of Internal Medicine, Harvard Medical School, Boston, MA, USA; 3School of Medicine, University of Jordan, Amman, Jordan; 4Department of Pathology and Laboratory Medicine, King Hussein Cancer Centre, Amman, JordanCorrespondence: Maysa Al-Hussaini Tel [phone]Fax [phone]Email [email protected]: The predictive value of inflammatory parameters as indicators of poor overall survival (OS) has been well studied in various tumors. This study aimed to explore the association of neutrophil-lymphocyte ratio (NLR), among other parameters in upper gastro-intestinal tract tumors with distant metastases and OS.Patients and Methods: Retrospective analysis was done for 945 patients (males n= 539, 57.0%) with a median of 57 years (range 19– 90 years) treated at King Hussein Cancer Center (KHCC) for gastric (n=501), pancreatic (n=355), and biliary (n=89) carcinoma. NLR, and other parameters were calculated at primary presentation, and the association between the parameters with baseline distant metastases and OS was studied. The optimal cutoff value of NLR was based on receiver operating characteristic curve (ROC) analysis. A prognostic nomogram was then constructed to explore how accurately the OS can be predicted.Results: Patients with high baseline NLR (> 3.2) had more distant metastases on presentation than patients with low NLR (≤ 3.2), (p-value < 0.001). Age older than 57 years was associated with poor median OS (8.7 versus 10.6 months, p-value=  0.04). In addition, the location of the tumor as stomach versus biliary tract (Odds Ratio 0.443 95% CI 0.281– 0.699), and pancreas versus biliary tract (Odds Ratio 1.193, 95% CI 0.749– 1.902, p-value < 0.001) proved to be significant. In multivariate analysis, age older than 57 years (p-value =0.0033, HR 0.792, 95% CI 0.678– 0.925), location of the tumor (p-value < 0.0001), presence of distant metastasis (p-value < 0.0001, HR 2.063, 95% CI 1.760– 2.419), and NLR (p-value < 0.0001, HR 1.045, 95% CI 1.028– 1.062) remained significant. Nomogram confirmed the significance of NLR as an independent prognostic factor for OS (HR = 1.62, 95% CI: 1.31– 2.01, p-value < 0.0001).Conclusion: Our results suggested that high baseline inflammatory markers are associated with distant metastases and poor OS. The utilization of this association in management of cancer patients still warrants further investigation.Keywords: stomach, pancreas, biliary tract, neutrophil to lymphocyte ratio, nomogram, metastasis

Keywords

• stomach
• pancreas
• biliary tract
• neutrophil to lymphocyte ratio
• nomogram
• metastasis.