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Prognostic value of an inflammation-based nutritional score for patients with initially unresectable pancreatic adenocarcinoma undergoing conversion surgery following chemo-/radiotherapy

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Abstract

Purpose

To clarify the prognostic value of the preoperative nutrition status of patients undergoing conversion surgery (CS) for initially unresectable pancreatic adenocarcinoma (UR-PA).

Methods

The subjects of this retrospective study were 41 consecutive patients with initially UR-PA treated with chemo-/radiotherapy and subsequent CS between 2007 and 2014, at Tohoku University Hospital. The preoperative Glasgow Prognostic Score (GPS) was 0, conveying normal nutrition, in 25 patients (N group) and 1–2, conveying malnutrition, in 16 patients (M group). The clinicopathological factors influencing overall survival were defined by uni- and multivariate analyses.

Results

The M group had a significantly worse prognosis than the N group (median overall survival (mOS) 9.6 vs 40.7 months, p = 0.001). Multivariate analysis identified a GPS of 1–2 as an independent predictor of worse prognosis [hazard ratio (HR)3.437, p = 0.032], followed by CA19-9 elevation before CS (HR4.089, p = 0.012) and pathological lymph node metastases (HR2.314, p = 0.046). Patients who maintained a favorable nutritional status (GPS 0) during preoperative treatment had a significantly better prognosis, whereas those whose nutritional status deteriorated (elevated to GPS 1–2) had poorer survival (mOS 40.7 vs. 9.7 months, p = 0.003)

Conclusion

Preoperative malnutrition status (GPS 1–2) is considered an independent predictor of a worse prognosis for patients undergoing CS for initially UR-PA.

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Acknowledgement

We thank all the surgeons, radiologists, and oncologists who performed preoperative therapies and pancreatectomies at our institutions. We also thank Shingo Yoshimachi, Tatsuo Hata, Takayuki Miura, Tatsuyuki Takadate, Kyohei Ariake, Kei Kawaguchi, Kunihiro Masuda, and Masaharu Ishida in the Department of Surgery, Tohoku University Graduate School of Medicine, Japan, who contributed to the conception of this work. This study was not supported by a research grant.

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Authors and Affiliations

  1. Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan

    Takashi Kokumai, Shuichi Aoki, Masamichi Mizuma, Shimpei Maeda, Hideo Ohtsuka, Kei Nakagawa, Takanori Morikawa, Takashi Kamei & Michiaki Unno

  2. Department of Surgery, Yamagata University Graduate School of Medical Science, Yamagata, Japan

    Fuyuhiko Motoi

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  1. Takashi Kokumai
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Correspondence to Shuichi Aoki.

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Kokumai, T., Aoki, S., Mizuma, M. et al. Prognostic value of an inflammation-based nutritional score for patients with initially unresectable pancreatic adenocarcinoma undergoing conversion surgery following chemo-/radiotherapy. Surg Today 51, 1682–1693 (2021). https://doi.org/10.1007/s00595-021-02279-5

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