Associations between Nutritional and Immune Status and Clinicopathologic Factors in Patients with Pancreatic Cancer: A Comprehensive Analysis
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. General Study Information: Inclusion and Exclusion Criteria
2.2. The Patients’ General Clinical and Pathological Characteristics
2.2.1. Clinical Patients’ Characteristics
2.2.2. Pathological Tumor Characteristics
2.3. Study Design
2.4. Ethics Approval and Consent to Participate
2.5. Statistical Analysis
3. Results
3.1. Comparison of Selected Clinicopathological Factors and Nutritional Parameters Depending on the Tumor Location
3.2. Comparison of Selected Clinicopathological Factors and Nutritional Parameters Depending on the Age
3.3. Comparison of Selected Clinicopathological Factors and Nutritional Parameters Depending on NRS 2002 Classification
3.4. Comparison of Selected Clinicopathological Factors and Nutritional Parameters Depending on PNI
3.5. Comparison of Selected Clinicopathological Factors and Nutritional Parameters Depending on Presence of Postoperative Complications
3.6. Comparison of Selected Clinicopathological Factors as Well as Immune and Nutritional Parameters Depending on the Use of Neoadjuvant Chemotherapy
3.7. Correlations between Selected Nutritional Parameters and Clinicopathological Factors
3.8. Regression Analysis for Association between Selected Nutritional Parameters and Clinicopathological Factors Including the Impact of NS on Postoperative Outcome
4. Discussion
4.1. Obesity as a Risk Factor for PC and Postoperative Morbidity Following Pancreatectomy
4.2. Nutritional Risk Factors for Postoperative Morbidity Following Pancreatectomy
4.3. Weight and WL in PC Patients
4.4. Association between Tumor Staging and Nutritional and Immune Parameters in PC Patients
4.5. The Prognostic Role of PNI in PC Patients
4.6. Correlations between PNI and Immune Ratios (NLR, MLR, PLR) in PC Patients
4.7. The Optimal Cutoff PNI Value in PC Patients
4.8. Association between Age and NS in PC Patients
4.9. Association between Tumor Location and NS in PC Patients
4.10. Association between Neoadjuvant Chemotherapy and NS in PC Patients
4.11. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | NRS 2002 | PNI | BMI | |||
---|---|---|---|---|---|---|
r | p | r | p | r | p | |
Age | 0.2624 | 0.0187 | −0.2077 | 0.1176 | −0.0489 | 0.6663 |
Weight loss | 0.6029 | <0.0001 | −0.2696 | 0.0407 | −0.2572 | 0.0212 |
BMI | −0.2438 | 0.0293 | 0.1798 | 0.1768 | - | - |
NRS 2002 | - | - | −0.2006 | 0.1311 | −0.2437 | 0.0293 |
Duration of hospitalization | 0.2603 | 0.0200 | −0.3082 | 0.0074 | −0.0444 | 0.6953 |
Total protein | −0.0455 | 0.6882 | 0.4779 | 0.0001 | 0.0769 | 0.4979 |
Albumin | −0.2040 | 0.0694 | 0.8778 | <0.0001 | −0.0884 | 0.5292 |
Total lymphocytes | 0.1127 | 0.4000 | 0.4726 | 0.0001 | 0.2464 | 0.0622 |
Hemoglobin | −0.1306 | 0.2480 | 0.1998 | 0.1326 | 0.2743 | 0.0138 |
PNI | −0.2006 | 0.1311 | - | - | 0.0753 | 0.6229 |
NLR | −0.0325 | 0.8187 | −0.3684 | 0.0072 | −0.2795 | 0.0047 |
MLR | 0.0418 | 0.7552 | −0.5388 | <0.0001 | −0.2255 | 0.0887 |
PLR | 0.0448 | 0.7382 | −0.4607 | 0.0003 | −0.3764 | 0.0036 |
CA 19.9 | 0.4776 | 0.045 | −0.4989 | 0.0694 | −0.0031 | 0.9903 |
CEA | 0.4573 | 0.049 | −0.1175 | 0.667 | −0.2175 | 0.3710 |
Model 1 | NRS 2002 R = 0.61041441 R2 = 0.37260575 Adjusted R2= 0.25496932 F(6.32) = 3.1674 p < 0.01489 Standard Error of Estimate: 1.1016 | ||||
Variable | b | Standard Error of b | p-Value | r | p-Value |
Intercept | 0.52943 | 2.395166 | 0.826465 | ||
Albumin | −0.08421 | 0.035573 | 0.024133 | −0.33147 | 0.024133 |
Biliary stenting | 0.88227 | 0.413646 | 0.0407 | 0.298654 | 0.0407 |
PNI groups <45 vs. >45 | 0.77489 | 0.526014 | 0.150482 | 0.206272 | 0.150482 |
Age | 0.03646 | 0.02173 | 0.103156 | 0.234909 | 0.103156 |
Lymph node invasion N0 vs. N+ | −1.21852 | 0.905103 | 0.187672 | −0.188508 | 0.187672 |
Hemoglobin | 0.12867 | 0.122136 | 0.299996 | 0.147515 | 0.299996 |
Model 2 | NRS 2002 R = 0.40506490 R2 = 0.16407757 Adjusted R2 = 0.13108064 F(3.76) = 4.9725 p < 0.00333 Standard Error of Estimate: 1.0355 | ||||
Variable | b | Standard Error of b | p-Value | r | p-Value |
Intercept | 1.180679 | 1.231398 | 0.340694 | ||
Albumin | −0.033543 | 0.016302 | 0.043057 | −0.215794 | 0.043057 |
Biliary stenting | 0.561976 | 0.24273 | 0.023301 | 0.242812 | 0.023301 |
Age | 0.02754 | 0.014375 | 0.049158 | 0.200916 | 0.049158 |
Model 1 | Albumin R = 0.83469799; R2 = 0.69672073; Adjusted R2 = 9.66104082 F(6.32) = 3.1674; p < 0.01489 Standard Error of Estimate: 1.1016 | ||||
Variable | b | Standard Error of b | p-Value | r | p-Value |
Intercept | 18.3744 | 5.52904 | 0.002186 | ||
PNI groups <45 vs. >45 | 10.859 | 1.522365 | <0.0001 | 0.660446 | <0.0001 |
NRS 2002 | −1.5923 | 0.595842 | 0.011611 | −0.24744 | 0.011611 |
Tumor (T) | 2.4223 | 1.57154 | 0.13276 | 0.142718 | 0.13276 |
NLR | 1.2282 | 0.511082 | 0.022037 | 0.222505 | 0.022037 |
MLR | −12.6804 | 5.825692 | 0.036766 | −0.20154 | 0.036766 |
Model 2 | Albumin R = 0.84681110; R2 = 0.71708904; Adjusted R2 = 0.67422374 F(5.33) = 16.729; p < 0.00000 Standard error of estimate: 4.4633 | ||||
Variable | b | Standard Error of b | p-Value | r | p-Value |
Intercept | 24.8288 | 3.682835 | <0.0001 | ||
PNI groups <45 vs. >45 | 10.3492 | 1.515783 | <0.0001 | 0.644842 | <0.0001 |
NRS 2002 | −1.8304 | 0.586996 | 0.003691 | −0.294509 | 0.003691 |
NLR | 1.2694 | 0.520608 | 0.020138 | 0.23028 | 0.020138 |
MLR | −13.7217 | 5.902307 | 0.026189 | −0.219567 | 0.026189 |
Variable | b | SE b | −95% CI | +95% CI | Wald Stat. | p-Value | OR | −95% CI | +95% CI |
---|---|---|---|---|---|---|---|---|---|
Intercept | −5.566193 | 2.566567 | −10.596571 | −0.535815 | 4.703395 | 0.030103 | 0.003825 | 0.000025 | 0.585192 |
Tumor location | −1.807345 | 1.090339 | −3.94437 | 0.32968 | 2.747636 | 0.097398 | 0.164089 | 0.019363 | 1.390523 |
Age groups ≤65 vs. >65 | 2.047763 | 0.806626 | 0.466806 | 3.628721 | 6.444886 | 0.011127 | 7.750546 | 1.594892 | 37.664613 |
Tumor staging (T) | 0.493388 | 0.755004 | −0.986392 | 1.973168 | 0.42705 | 0.51344 | 1.637856 | 0.37292 | 7.193428 |
Lymph node invasion (N) | −1.700343 | 1.17609 | −4.005436 | 0.604751 | 2.09022 | 0.148245 | 0.182621 | 0.018216 | 1.830796 |
Distal metastases (M) | 3.008428 | 1.199774 | 0.656913 | 5.359943 | 6.28753 | 0.012159 | 20.255535 | 1.928829 | 212.712803 |
Smoking | 0.667835 | 0.782185 | −0.865219 | 2.200889 | 0.728987 | 0.393212 | 1.950012 | 0.420959 | 9.033043 |
Weight loss% groups | 1.661909 | 0.482011 | 0.717185 | 2.606634 | 11.887779 | 0.000565 | 5.269362 | 2.048658 | 13.553349 |
Neoadjuvant chemotherapy | 2.489666 | 0.995638 | 0.538252 | 4.441081 | 6.252871 | 0.012399 | 12.057251 | 1.71301 | 84.866596 |
Variable | b | SE b | −95% CI | +95% CI | Wald Stat. | p-Value | OR | −95% CI | +95% CI |
---|---|---|---|---|---|---|---|---|---|
Intercept | −3.903865 | 1.191759 | −6.23967 | −1.56806 | 10.730317 | 0.001054 | 0.020164 | 0.00195 | 0.208449 |
BMI groups <30 vs. ≥30 | 2.154665 | 0.989986 | 0.214328 | 4.095002 | 4.736977 | 0.029521 | 8.625 | 1.239029 | 60.03947 |
NRS 2002 groups <3 vs. ≥3 | 1.056053 | 0.600853 | −0.121598 | 2.233704 | 3.089115 | 0.048818 | 2.875 | 0.885504 | 9.334375 |
Neoadjuvant chemotherapy0 vs. 1 | −0.60343 | 1.214431 | −2.98367 | 1.776811 | 0.246892 | 0.619272 | 0.546933 | 0.050607 | 5.910974 |
Model 1 | Duration of Postoperative Hospitalization R = 0.40222591; R2 = 0.16178568; Adjusted R2 = 0.12089718 F(2.41) = 3.9568; p < 0.02684; Standard Error of Estimate: 10.589 | ||||
---|---|---|---|---|---|
Variable | b | Standard Error of b | p-Value | r | p-Value |
Intercept | 22.26649 | 5.538050 | 0.000243 | ||
NRS 2002 groups <3 vs. ≥3 | 7.67948 | 3.692033 | 0.043816 | 0.297407 | 0.043816 |
Total protein <6.0 vs. ≥6.0 g/dL | −5.78857 | 3.251591 | 0.082451 | −0.254543 | 0.082451 |
Model 1 | Complications R = 0.32669159; R2 = 0.10672739; Adjusted R2 = 0.09527518; F(1.78) = 9.3194; p < 0.00310 Standard Error of Estimate: 0.39970 | ||||
---|---|---|---|---|---|
Variable | b | Standard Error of b | p-Value | r | p-Value |
Intercept | 0.095238 | 0.107015 | 0.126588 | ||
Duration of postoperative hospitalization ≤10 vs. >10 days | 0.273183 | 0.089487 | 0.003100 | 0.326691 | 0.003100 |
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Jabłońska, B.; Pawlicki, K.; Mrowiec, S. Associations between Nutritional and Immune Status and Clinicopathologic Factors in Patients with Pancreatic Cancer: A Comprehensive Analysis. Cancers 2021, 13, 5041. https://doi.org/10.3390/cancers13205041
Jabłońska B, Pawlicki K, Mrowiec S. Associations between Nutritional and Immune Status and Clinicopathologic Factors in Patients with Pancreatic Cancer: A Comprehensive Analysis. Cancers. 2021; 13(20):5041. https://doi.org/10.3390/cancers13205041
Chicago/Turabian StyleJabłońska, Beata, Krzysztof Pawlicki, and Sławomir Mrowiec. 2021. "Associations between Nutritional and Immune Status and Clinicopathologic Factors in Patients with Pancreatic Cancer: A Comprehensive Analysis" Cancers 13, no. 20: 5041. https://doi.org/10.3390/cancers13205041