Abstract：
BACKGROUND: Despite a strong association between nutritional indices and disease prognosis, evidence regarding the evaluation of nutritional indices after preoperative treatment for pancreatic ductal adenocarcinoma (PDAC) is insufficient. We evaluated the clinical significance of the prognostic nutritional index (PNI) in patients with resectable (R-) and borderline resectable (BR-) PDAC who received neoadjuvant chemoradiotherapy (NACRT) followed by pancreatic resection.
METHODS: We assessed 153 patients with R- and BR-PDAC who underwent NACRT followed by curative resection between 2009 and 2022. We evaluated the association between preoperative PNI after NACRT and short- and long-term outcomes.
RESULTS: The median preoperative PNI value after NACRT was 42.1, and the optimal cutoff value from the time-dependent receiver operating characteristic curve was 38.6. The low PNI group (PNI < 38.6, n = 44) exhibited significantly worse inflammatory parameters, surgical outcomes, and prognoses than the high PNI group (PNI ≥ 38.6, n = 109). Multivariate analysis identified preoperative PNI ≤ 38.6 (hazard ratio [HR]: 2.32, 95% confidence interval [CI]: 1.00-5.38, p = .049), blood loss ≥1642 mL (HR: 3.05, 95% CI: 1.65-5.64, p < .001), node positive pathology (HR: 2.10, 95% CI: 1.32-3.34, p = .002), and lack of postoperative adjuvant chemotherapy (HR: 3.55, 95% CI: 2.05-6.15, p < .001) as significant predictors of overall survival.
CONCLUSIONS: For patients with R- and BR-PDAC receiving preoperative treatment, it is imperative to closely monitor their nutritional status when determining the optimal surgical procedure timing.
METHODS: We assessed 153 patients with R- and BR-PDAC who underwent NACRT followed by curative resection between 2009 and 2022. We evaluated the association between preoperative PNI after NACRT and short- and long-term outcomes.
RESULTS: The median preoperative PNI value after NACRT was 42.1, and the optimal cutoff value from the time-dependent receiver operating characteristic curve was 38.6. The low PNI group (PNI < 38.6, n = 44) exhibited significantly worse inflammatory parameters, surgical outcomes, and prognoses than the high PNI group (PNI ≥ 38.6, n = 109). Multivariate analysis identified preoperative PNI ≤ 38.6 (hazard ratio [HR]: 2.32, 95% confidence interval [CI]: 1.00-5.38, p = .049), blood loss ≥1642 mL (HR: 3.05, 95% CI: 1.65-5.64, p < .001), node positive pathology (HR: 2.10, 95% CI: 1.32-3.34, p = .002), and lack of postoperative adjuvant chemotherapy (HR: 3.55, 95% CI: 2.05-6.15, p < .001) as significant predictors of overall survival.
CONCLUSIONS: For patients with R- and BR-PDAC receiving preoperative treatment, it is imperative to closely monitor their nutritional status when determining the optimal surgical procedure timing.
摘要：
背景：尽管营养指数和疾病预后之间有很强的关联，关于胰腺导管腺癌(PDAC)术前治疗后营养指标评估的证据不足.我们评估了接受新辅助放化疗（NACRT）后进行胰腺切除术的可切除（R-）和临界可切除（BR-）PDAC患者的预后营养指数（PNI）的临床意义。
方法：我们评估了在2009年至2022年期间接受NACRT和根治性切除术的153例R-和BR-PDAC患者。我们评估了NACRT后的术前PNI与短期和长期结局之间的关联。
结果：NACRT后的术前PNI中值为42.1，来自时间依赖性受试者工作特征曲线的最佳截止值为38.6。低PNI组（PNI<38.6，n=44）表现出明显较差的炎症参数，手术结果,和预后高于高PNI组(PNI≥38.6，n=109)。多变量分析确定术前PNI≤38.6（风险比[HR]：2.32，95％置信区间[CI]：1.00-5.38，p=.049），失血量≥1642mL(HR:3.05,95%CI:1.65-5.64,p<.001),淋巴结阳性病理（HR：2.10，95%CI：1.32-3.34，p=0.002），和缺乏术后辅助化疗(HR:3.55,95%CI:2.05-6.15,p<.001)作为总生存期的显著预测因子。
结论：对于接受术前治疗的R-和BR-PDAC患者，在确定最佳手术时机时，必须密切监测其营养状况。
方法：我们评估了在2009年至2022年期间接受NACRT和根治性切除术的153例R-和BR-PDAC患者。我们评估了NACRT后的术前PNI与短期和长期结局之间的关联。
结果：NACRT后的术前PNI中值为42.1，来自时间依赖性受试者工作特征曲线的最佳截止值为38.6。低PNI组（PNI<38.6，n=44）表现出明显较差的炎症参数，手术结果,和预后高于高PNI组(PNI≥38.6，n=109)。多变量分析确定术前PNI≤38.6（风险比[HR]：2.32，95％置信区间[CI]：1.00-5.38，p=.049），失血量≥1642mL(HR:3.05,95%CI:1.65-5.64,p<.001),淋巴结阳性病理（HR：2.10，95%CI：1.32-3.34，p=0.002），和缺乏术后辅助化疗(HR:3.55,95%CI:2.05-6.15,p<.001)作为总生存期的显著预测因子。
结论：对于接受术前治疗的R-和BR-PDAC患者，在确定最佳手术时机时，必须密切监测其营养状况。
