Metastatik Pankreas Kanseri Olan Hastalarda GRIm Skoru ile Prognoz Arasındaki İlişki

Abstract

Amaç: Laktat dehidrogenaz (LDH), albümin ve nötrofil/lenfosit oranını (NLR) birleştiren Gustave Roussy Immün (GRIm) skoru, pratik bir immün–nutrisyonel indeks olarak öne çıkmıştır; ancak metastatik pankreas adenokarsinomunda kanıtlar sınırlıdır. Bu çalışma, sistemik tedavi alan hastalarda GRIm skorunun progresyonsuz sağkalım (PFS) ve genel sağkalım (OS) üzerindeki prognostik değerini değerlendirmeyi amaçladı. Yöntemler: Bu retrospektif çalışma, 2020–2024 yılları arasında sistemik tedavi alan metastatik pankreas kanseri tanılı 94 hastayı içerdi. GRIm skorunu hesaplamak için başlangıç LDH, albümin ve nötrofil-lenfosit oranı (NLR) kullanıldı. Her olumsuz faktör (yüksek LDH, hipoalbüminemi ve artmış NLR) için bir puan verildi ve 0 ile 3 arasında değişen toplam bir skor elde edildi; hastalar daha sonra düşük (0-1) veya yüksek (2-3) GRIm olarak kategorize edildi. Sonuçlar: Ortalama yaş 59.9 ± 10.1 yıl olup 59 hasta erkekti (%62.8). GRIm skoru dağılımı %33.0’da 0, %42.6’da 1 ve %24.5’te 2–3 idi. Medyan takip süresi 9 ay (aralık, 1–36) olup progresyon %74.5’te, mortalite %84’te görüldü. Medyan PFS 5.0 ay (IQR, 1.0–10.0) idi. GRIm arttıkça sonlanım noktaları basamaklı olarak kötüleşti: GRIm 0, 1 ve 2–3 için medyan PFS sırasıyla 9, 6 ve 2 ay idi (p<0.001) ve medyan OS 14, 10 ve 4 ay idi (p<0.001). Çok değişkenli analizlerde, GRIm 2–3, GRIm 0’a kıyasla hem progresyonu (PFS: HR 3.64, %95 GA 1.95–6.82, p<0.001) hem de ölümü (OS: HR 2.15, %95 GA 1.09–4.22, p=0.027) bağımsız olarak öngördü; buna karşın GRIm 1 anlamlı değildi. Sonuç: Yüksek GRIm skoru; hastalık evresi, metastatik yük ve tedavi rejiminden bağımsız olarak daha kötü PFS ve OS ile ilişkiliydi. GRIm skoru, metastatik pankreas kanserinde basit ve pratik bir prognostik biyobelirteçtir.

Keywords

• pankreas kanseri
• metastatic
• GRIm skoru
• progresyonsuz sağkalım
• genel sağkalım

Ethical Statement

Bu çalışma Helsinki Bildirgesi'ne uygun olarak gerçekleştirilmiş ve Başakşehir Çam ve Sakura Şehir Hastanesi Etik Kurulu tarafından onaylanmıştır (Onay Tarihi: 22.08.2025, Karar No: 2025/279).

The Relationship Between GRIm Score and Prognosis in Patients with Metastatic Pancreatic Cancer

Abstract

Aims: The Gustave Roussy Immune (GRIm) score, integrating lactate dehydrogenase (LDH), albumin, and neutrophil-to-lymphocyte ratio (NLR), has emerged as a practical immune–nutritional index; however, evidence in metastatic pancreatic adenocarcinoma remains limited. This study aimed to evaluate the prognostic value of the GRIm score for progression-free survival (PFS) and overall survival (OS) in patients receiving systemic therapy. Methods: This retrospective study included 94 patients diagnosed with metastatic pancreatic cancer who received systemic therapy between 2020 and 2024. Baseline LDH, albumin, and neutrophil-to-lymphocyte ratio (NLR) were used to compute the GRIm score. One point was assigned for each adverse factor (elevated LDH, hypoalbuminemia, and increased NLR), yielding a total score ranging from 0 to 3; patients were then categorized as low (0–1) or high (2–3) GRIm. Results: The mean age was 59.9 ± 10.1 years and 59 patients were men (62.8%). GRIm score distribution was 0 in 33.0%, 1 in 42.6%, and 2–3 in 24.5%. Median follow-up was 9 months (range, 1–36); progression occurred in 74.5% and mortality in 84%. Median PFS was 5.0 months (IQR, 1.0–10.0). Outcomes deteriorated stepwise with increasing GRIm: median PFS was 9, 6, and 2 months for GRIm 0, 1, and 2–3, respectively (p<0.001), and median OS was 14, 10, and 4 months (p<0.001). In multivariable analyses, GRIm 2–3 independently predicted both progression (PFS: HR 3.64, 95% CI 1.95–6.82, p<0.001) and death (OS: HR 2.15, 95% CI 1.09–4.22, p=0.027) compared with GRIm 0, whereas GRIm 1 was not significant. Conclusion: A high GRIm score was associated with worse PFS and OS, independent of disease stage, metastatic burden, and treatment regimen. The GRIm score is a simple, practical prognostic biomarker in metastatic pancreatic cancer.

Keywords

• pancreatic cancer
• metastatic
• GRIm score
• progression-free survival
• overall survival

Ethical Statement

This study was performed in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Basakşehir Çam ve Sakura City Hospital (Approval Date: 22.08.2025, Decision No: 2025/279).

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