Pankreas kanserinde vasküler invazyon ve inoperabilitenin değerlendirilmesinde hematolojik parametrelerin ve CA 19-9’un önemi

Abstract

Amaç: Bu çalışmada, pankreas kanserli hastaların laboratuvar verileri üzerinden rezeke edilebilen ve edilemeyen hastalar karşılaştırılarak, hematolojik parametrelerin ve CA19-9’un inoperabilitenin değerlendirilmesinde prediktif faydası araştırıldı. Gereç ve Yöntem: Çalışmaya 2015-2021 yılları arasında Hitit Üniversitesi Erol Olçok Eğitim ve Araştırma Hastanesi’nde pankreas kanseri teşhisi konan 147 birey dahil edildi. Hastalar ameliyat olanlar (grup 1) ve ameliyat olamayanlar (grup 2) olmak üzere iki gruba ayrıldı. Trombosit/ortalama trombosit hacim oranı (P/MPV), trombosit/trombosit dağılım hacim oranı (P/PDW), nötrofil/lenfosit oranı (NLR), lenfosit/monosit oranı (LMR) ve C-reaktif protein/lenfosit (CRP/L) oranları hesaplandı. Bulgular: Hastaların NLO, kitle boyutu, CRP/L, C reaktif protein (CRP) ve Ca-19.9 düzeyleri gruplar arasında karşılaştırıldığında anlamlı fark görüldü. Grup 2’de yer alan ve superior mezenterik arter (SMA), superior mesenteric ven (SMV) invazyonu olan hastalar (n:26) Grup I ile karşılaştırıldığında; yaş, NLR, kitle boyutu, P/PDW, P/MPV, CRP, CRP/L, trombosit dağılım hacim (PDW) ve Ca 19-9 değerleri arasında istatistiksel fark saptandı. Sonuç: Bu çalışmada, NLR, CRP, CRP/L, CA 19-9 seviyeleri ve tümör kitlesinin, rezektabl cerrahi şansını belirlemede önemli ölçüde ilişkili olduğu ortaya çıktı. Rezektabl olmama veya vasküler invazyon durumlarında, bu değerlerin gereksiz laparotomileri önlememize yardımcı olabileceğini tahmin ediyoruz.

Keywords

• Pankreas kanseri
• vasküler invazyon
• rezektabl olmama

The significance of haematological parameters and CA 19-9 in assessing vascular invasion and inoperability in pancreatic cancer

Abstract

Aim: In this study, by comparing resectable and unresectable patients over the laboratory data of patients with pancreatic cancer, the predictive usefulness of haematological parameters and CA19-9 in the evaluation of inoperability was explored. Material and Method: The study included 147 individuals diagnosed with pancreatic cancer at Hitit Univesity Erol Olçok Training and Research Hospital between 2015 and 2021. Patients were divided into two groups: those who had surgery (group 1) and those who were unable to have surgery (group 2). The platelet/mean platelet volume ratio (P/MPV), platelet/platelet distribution volume ratio (P/PDW), neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR), and C- reactive protein/lymphocyte ratios (CRP/L) were all calculated. Result: When the patients’ NLR, mass size, CRP/L, CRP, and CA-19.9 levels were compared between groups, a significant difference was observed. When the age, NLR, mass size, P/PDW, P/MPV, CRP (C reactive protein), CRP/L, platelet distribution volume (PDW), and CA 19-9 values of patients in Group 2 with superior mesenteric artery (SMA) and superior mesenteric vein (SMV) invasion (n:26) were compared to those in Group I, a statistical difference was detected. Conclusion: In this study, NLR, CRP, CRP/L, CA 19-9 levels, and tumour mass were revealed to be significantly relevant in determining the chance of resectable surgery. In cases of unresectability or vascular invasion, we anticipate that these values can assist us prevent unnecessary laparotomies.

Keywords

• Pancreatic cancer
• vascular invasion
• unresectability

References

1. Siegel RL, Miller KD, Jemal A. CA cancer statistic, 2019 Cancer J Clin 2019; 69: 7-34.
2. Vincent A, Herman J, Schulick R, Hruban RH, Goggins M. Pancreatic cancer. Lancet 2011; 378: 607-20.
3. Seufferlein T, Bachet JB, VanCutsem E, Rougier P; ESMO Guidelines Working Group. Pancreatic adenocarcinoma: ESMO-ESDO clinical practice guidelines for diagnosis, treatment, and follow-up. Ann Oncol 2012; 23: vii33-40
4. Valls C, Andía E, Sanchez A, et al. Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery. AJR Am J Roentgenol 2002; 178: 821-26.
5. Rickes S, Unkrodt K, Neye H, Ocran KW, Wermke W. Scand differentiation of pancreatic tumours by conventional ultrasound, unenhanced and echo-enhanced power Doppler sonography. J Gastroenterol 2002; 37: 1313-20.
6. Takhar AS, Palaniappan P, Dhingsa R, Lobo DN. Recent developments in diagnosis of pancreatic cancer BMJ 2004; 329: 668–73.
7. Tempero MA. NCCN guidelines updates: Pancreatic cancer. J Natl Compr Canc Netw 2019; 17: 603-5.
8. McGuigan A, Kelly P, Turkington RC, et al. Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol 2018; 24: 4846–61.

9. Modi B, Shires GT. Pancreatic cancer, cystic pancreatic neoplasms, and other nonendocrine pancreatic tumor. In: Feldman M, Friedman L, Brandt L; eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 11th ed. Elsevier 2020. p.947-65.
10. Shaib YH, Davila JA, El-Serag HB The epidemiology of pancreatic cancer in the United States: changes below the surface. Aliment Pharmacol Ther 2006; 24: 87-94.
11. Phoa SS, Tilleman EH, van Delden OM, Bossuyt PM, Gouma DJ, Laméris JS. Value of CT criteria in predicting survival in patients with potentially resectable pancreatic head carcinoma. J Surg Oncol 2005; 91: 33-40.
12. Chatelain D, Fléjou JF. Pancreatectomy for adenocarcinoma: prognostic factors, recommendations for pathological reports. Ann Pathol 2002; 22: 422-31.
13. Takahashi C, Shridhar R, Huston J, Meredith K. Correlation of tumor size and survival in pancreatic cancer. J Gastrointest Oncol 2018; 9: 910-21.
14. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell 2010; 140: 883-99.
15. Bhatti I, Peacock O, Lloyd G, Larvin M, Hall RI. Preoperative hematologic markers as independent predictors of prognosis in resected pancreatic ductal adenocarcinoma: neutrophil-lymphocyte versus platelet-lymphocyte ratio. Am J Surg 2010; 200: 197-203.
16. Teo M, Mohd Sharial MS, McDonnell F, Conlon KC, Ridgway PF, McDermott RS. Prognostic role of neutrophil-to-lymphocyte ratio in advanced pancreatic ductal adenocarcinoma: impact of baseline fluctuation and changes during chemotherapy. Tumori 2013; 99: 516-22.
17. Stotz M, Gerger A, Eisner F, et al. Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer Br J Cancer 2013; 109: 416-21.
18. Wiese D, Kampe K, Waldmann J, Heverhagen AE, Bartsch DK, Fendrich V. C-reactive protein as a new prognostic factor for survival in patients with pancreatic neuroendocrine neoplasia. J Clin Endocrinol Metab 2016; 101: 937-44.
19. Fan Z, Luo G, Gong Y, et al. Prognostic Value of the C-reactive protein/lymphocyte ratio in pancreatic cancer. Ann Surg Oncol 2020; 27: 4017-25.
20. Schimmack S, Yang Y, Felix K, et al. C-reactive protein (CRP) promotes malignant properties in pancreatic neuroendocrine neoplasms Endocr Connect 2019; 8: 1007–19.
21. Kim YC, Kim HJ, Park JH, et al. Can preoperative CA19-9 and CEA levels predict the resectability of patients with pancreatic adenocarcinoma? J Gastroenterol Hepatol 2009; 24: 1869-75.
22. Maithel SK, Maloney S, Winston C, et al Preoperative CA 19-9 and the yield of staging laparoscopy in patients with radiographically resectable pancreatic adenocarcinoma. Ann Surg Oncol 2008; 15: 3512-20.