Inflammatory and nutritional biomarkers as predictors of non-resectability and early recurrence in pancreatic and periampullary cancer.

Background: Some pancreatic tumors considered resectable on the preoperative staging are unresectable during surgical exploration. Moreover, some patients subjected to tumor resection have an early recurrence.

Methods: Patients with pancreatic or periampullary carcinoma diagnosed between January 2005 and August 2017 at the Prof. Doutor Fernando Fonseca Hospital were retrospectively analyzed. Biochemical and radiological inflammatory biomarkers were compared according to disease staging at diagnosis, intraoperative staging and early recurrence (<6 months).

Results: Three hundred ninety-one patients were included. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio, C-reactive-protein-to-albuminemia ratio (CRP/ALB), Prognostic Nutritional Index, modified Glasgow Prognostic Score and CA19-9 were associated with metastatic disease at diagnosis. NLR, CRP/ALB, mGPS and CA19-9 were independent predictors of disease staging at diagnosis on multivariate analysis. One hundred eight patients underwent surgery, of which 23.8% were found to have unresectable disease at intra-operative staging. 26.9% had early disease recurrence. CRP/ALB and CA19-9 were significantly higher in patients with evidence of disease at 6 months postoperatively. Computed tomography sarcopenia index HUAC was significantly lower in patients with evidence of disease at 6 months postoperatively. When adjusted for histology, none of the biomarkers were independent predictors of unresectable disease or early recurrence.

Conclusions: NLR, CRP/ALB, mGPS and CA19-9 at diagnosis were predictors of disease staging with low performance. Preoperative inflammatory biomarkers were not predictors of unresectable disease or early recurrence.