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.
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。