Additive value of pre-operative and one-month post-operative lymphocyte count for death-risk stratification in patients with resectable pancreatic cancer: a multicentric study

BMC Cancer

Research Article

Zaher Lakkis¹  Bruno Heyd¹  Celia Turco¹  Gaël Simone²  Philippe Bachellier²  Najib Lamfichek³  Anne Berger⁴  Anne-Laure Pointet⁵  Julien Taieb⁵  Christelle d’Engremont⁶  Lucine Vuitton⁶  Francine Fein⁶  Stéphane Koch⁶  Stefano Kim⁷  Marine Jary⁷  Christophe Borg⁸  Franck Bonnetain⁹  Dewi Vernerey⁹ 

[1] Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France;Department of Digestive Surgery and Liver Transplantation, University hospital of Strasbourg, Strasbourg, France;Department of Digestive Surgery, Hospital of Belfort-Montbeliard, Montbeliard, France;Department of GI Surgery, Paris Descartes University, Georges Pompidou European Hospital, Paris, France;Department of Gastroenterology and GI oncology, Paris Descartes University, Georges Pompidou European Hospital, Paris, France;Department of Gastroenterology, University Hospital of Besançon, Besançon, France;Department of Medical Oncology, University Hospital of Besançon, Besançon, France;Department of Medical Oncology, University Hospital of Besançon, Besançon, France;Centre investigation Clinique en biothérapie, CIC-1431, Besançon, France;UMR1098 INSERM/Université de Franche Comté/Etablissement Français du Sang, Besançon, France;Department of Oncology, University Hospital of Besançon, 3 Boulevard Alexander Fleming, F-25030, Besancon, France;Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France;

关键词: Pancreatic adenocarcinoma;    Lymphocyte count;    Lymphopenia;    Prognosis;   

DOI  :  10.1186/s12885-016-2860-6

 received in 2016-02-16, accepted in 2016-10-20,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundPancreatic adenocarcinoma (PDAC) incidence is increasing worldwide. Several studies have shown that lymphopenia was correlated with a poor prognosis but the potential interest to measure lymphopenia in the pre and post-operative setting as well as its added value among conventional prognostic factors was never investigated.MethodsData from two independent cohorts in whom patients underwent resection for pancreatic carcinoma were retrospectively recorded. We examined the association between perioperative findings, pre and post-operative lymphocyte counts and overall survival (OS) in univariate and multivariate analyses. Performance assessment and internal validation of the final model were evaluated with Harrell’s C-index, calibration plot and bootstrap sample procedures.ResultsThree hundred ninety patients were included in the analysis between 2000 and 2011. Pre and post-operative lymphocyte counts were independent prognostic factors associated with OS in multivariate analysis (p = 0.0128 and p = 0.0764, respectively). The addition of lymphocyte count variable to the conventional parameters identified in multivariate analysis (metastatic lymph node ratio, veinous emboli and adjuvant chemotherapy) significantly improved the model discrimination capacity (bootstrap mean difference = 0.04; 95 % CI, 0.01–0.06). The use of a threshold and combining the categorical (≥1000; <1000) information in pre and post lymphocyte counts permitted the identification of 4 subgroups of patients with different prognosis (p < 0.0001). Finally, the description of patients in long-term remission showed that only 3 of 65 (4.6 %) patients with post-operative lymphocyte count under 1000/mm3 were alive 4 years after surgery contrary to 54 of 236 (22.8 %) patients with a post-operative lymphocyte count above 1000/mm3.ConclusionPre and post-operative lymphopenia are independent prognostic factors for OS and they have an additive value regarding conventional prognostic factors for death-risk stratification and to predict long-term survival. Lymphopenia should be included as stratification factors in future clinical trial assessing overall survival in pancreatic cancer patients.

【 授权许可】

CC BY   
© The Author(s). 2016