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. 2022 Sep 15;12(9):4267-4278.
eCollection 2022.

Predictive value of albumin combined with neutrophil-to-lymphocyte ratio for efficacy and safety profiles in patients with pancreatic ductal adenocarcinoma receiving liposomal irinotecan plus 5-fluorouracil and leucovorin

Yen-Yang Chen  1 , Shun-Wen Hsueh  2 , Shih-Hung Yang  3 , Sz-Chi Chiu  4 , Nai-Jung Chiang  5   6   7 , Tai-Jan Chiu  1 , Chung-Pin Li  7   8   9 , Li-Yuan Bai  10 , Chang-Fang Chiu  10 , Shih-Chang Chuang  11 , Yan-Shen Shan  12 , De-Chuan Chan  13 , Li-Tzong Chen  5 , Chia-Jui Yen  6 , Cheng-Ming Peng  14 , Jen-Shi Chen  15 , Wen-Chi Chou  15
Affiliations

Predictive value of albumin combined with neutrophil-to-lymphocyte ratio for efficacy and safety profiles in patients with pancreatic ductal adenocarcinoma receiving liposomal irinotecan plus 5-fluorouracil and leucovorin

Yen-Yang Chen et al. Am J Cancer Res. .

Abstract

Liposomal irinotecan plus 5-fluorouracil and leucovorin (nal-IRI + 5-FU/LV) treatment has demonstrated survival benefits but noticeable side effects in patients with pancreatic ductal adenocarcinoma (PDAC) that is refractory to gemcitabine-based therapy. This study aimed to explore whether combining albumin with the neutrophil-to-lymphocyte ratio (NLR), herein known as the albumin and neutrophil-to-lymphocyte ratio score (ANS), could be utilized as a simple tool to predict survival and safety profiles in such patient groups. We retrospectively enrolled 434 consecutive PDAC patients treated with nal-IRI + 5-FU/LV between 2018 and 2020 at nine medical centers in Taiwan. Patients were divided into three groups: ANS 0 (high albumin and low NLR), ANS 1 (low albumin or high NLR), and ANS 2 (low albumin and high NLR), for comparison. The median overall survival times for the ANS 0, 1, and 2 groups were 8.7 months (95% confidence interval (CI), 7.0-10.3 months), 5.2 months (95% CI, 4.3-6.0 months), and 2.6 months (95% CI, 1.9-3.3 months), respectively. The ANS was found to be an independent variable for overall survival and time-to-treatment failure in multivariate analyses. Patients in the ANS 2 group had significantly higher incidences of grade 3 or higher treatment-related adverse events than those in the other two groups. The present study showed that the ANS was an independent prognosticator in PDAC patients receiving nal-IRI + 5-FU/LV therapy. The ANS can be a simple predictor of survival outcome and safety profiles in PDAC patients treated with nal-IRI + 5-FU/LV.

Keywords: Albumin; liposomal irinotecan; neutrophil-to-lymphocyte ratio; pancreatic cancer; prognosis.

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Conflict of interest statement

Author Sz-Chi Chiu was employed by the company PharmaEngine, Inc. The remaining authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
Overall survival and time-to-treatment failure curves.
Figure 2
Figure 2
Kaplan-Meier estimates of overall survival (A) and time-to-treatment failure (B) among three ANS groups. ANS, albumin and neutrophil-to-lymphocyte ratio score.
Figure 3
Figure 3
Hazard ratio for overall survival (A) and time-to-treatment failure (B) in patients with different ANS groups; ANS, albumin and neutrophil-to-lymphocyte ratio score.
Figure 4
Figure 4
Best tumor responses to nal-IRI + 5-FU/LV treatment in patients from different ANS groups; ANS: albumin and neutrophil-to-lymphocyte ratio score; nal-IRI + 5-FU/LV: liposomal irinotecan plus 5-fluorouracil and leucovorin.
See this image and copyright information in PMC

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