Markers of tumor inflammation as prognostic factors for overall survival in patients with advanced pancreatic cancer receiving first-line FOLFIRINOX chemotherapy

Authors

  • Konstantinos Kamposioras Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
  • George Papaxoinis Second Department of Oncology, Agios Savvas Anticancer Hospital, Athens, Greece
  • Mohamed Dawood Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
  • Jordan Appleyard Barts and The London School of Medicine and Dentistry, London, UK
  • Fiona Collinson Department of Medical Oncology, Leeds Institute for Medical Research, St James' Institute of Oncology, St James' University Hospital, University of Leeds, Leeds, UK
  • Angela Lamarca Department of Medical Oncology, The Christie NHS Foundation Trust/Division of Cancer Sciences, University of Manchester, Manchester, UK
  • Usman Ahmad Department of Medical Oncology, The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
  • Richard A. Hubner Department of Medical Oncology, The Christie NHS Foundation Trust/Division of Cancer Sciences, University of Manchester, Manchester, UK
  • Francesca Wright Department of Medical Oncology, Leeds Institute for Medical Research, St James' Institute of Oncology, St James' University Hospital, University of Leeds, Leeds, UK
  • Rille Pihlak Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
  • Iva Damyanova Department of Medical Oncology, The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
  • Bilal Razzaq Department of Medical Oncology, The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
  • Juan W. Valle Division of Cancer Sciences, University of Manchester/The Christie NHS Foundation Trust, Manchester, UK
  • Mairéad G. McNamara Division of Cancer Sciences, University of Manchester/The Christie NHS Foundation Trust, Manchester, UK
  • Alan Anthoney Department of Medical Oncology, Leeds Institute for Medical Research, St James' Institute of Oncology, St James' University Hospital, University of Leeds, Leeds, UK

DOI:

https://doi.org/10.1080/0284186X.2022.2053198

Keywords:

Pancreatic adenocarcinoma, inflammation, biomarkers, prognosis, systemic inflammatory response index

Abstract

Background

Identifying pretreatment blood markers that distinguish prognostic groups of patients with advanced pancreatic ductal adenocarcinoma (PDAC) under first-line FOLFIRINOX chemotherapy has the potential to improve management of this condition. Aim of this study was to determine the prognostic utility of a range of pretreatment, inflammation-related, blood cell markers in this group of patients.

Material and methods

Data from a training cohort were analyzed to identify potential pretreatment blood markers correlating to survival outcomes. The most informative markers were further analyzed in a validation cohort comprised patients from a geographically separate cancer center undergoing the same treatment.

Results

A total of 138 consecutive patients receiving FOLFIRINOX chemotherapy between 2010 and 2019, constituted the training cohort. Neutrophil/lymphocyte (NLR), monocyte/lymphocyte (MLR), and platelet/lymphocyte ratio (PLR) as well as the systemic inflammatory response index (SIRI) and CA19.9 showed prognostic significance in addition to tumor stage. A pretreatment SIRI score cutoff of 2.35 differentiated between a poor prognostic group with median overall survival (mOS) 5.1 months and a better prognostic group, mOS 12.5 months. SIRI ≤/> 2.35 was predictive of mOS in patients with locally advanced and metastatic PDAC. SIRI was confirmed as a prognostic marker in a validation cohort of 67 patients with mOS of 13.4 months and 6.3 months for those with SIRI ≤ 2.35 and >2.35, respectively. Additional analysis revealed baseline SIRI as being prognostic within additional subgroups of patients in both cohorts.

Conclusions

This large, retrospective, analysis of real-world patients receiving first-line FOLFIRINOX chemotherapy for advanced PDAC has identified the pretreatment blood SIRI as a strong prognostic marker for survival. This will allow better counseling of patients with regards to the benefits of treatment, improved stratification within clinical trials, and potentially identify groups of patients for novel therapy trials as first-line treatment.

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Published

2022-05-04

How to Cite

Kamposioras, K., Papaxoinis, G., Dawood, M., Appleyard, J., Collinson, F., Lamarca, A., … Anthoney, A. (2022). Markers of tumor inflammation as prognostic factors for overall survival in patients with advanced pancreatic cancer receiving first-line FOLFIRINOX chemotherapy. Acta Oncologica, 61(5), 583–590. https://doi.org/10.1080/0284186X.2022.2053198

Issue

Vol. 61 No. 5 (2022): Acta Oncologica

Section

Articles