| Objective(s): To investigate the prognostic value of preoperative systemic inflammatory response index(SIRI)and fibrinogen/albumin(FAR)from peripheral blood in patients with pancreatic cancer after radical resection,and to compare the prognostic ability of SIRI-FAR combined index and independent index in patients with pancreatic cancer.Methods: Clinical data of patients with pancreatic cancer who underwent surgical treatment and were confirmed by postoperative pathology in the Second Affiliated Hospital of Kunming Medical University from January 2014 to January2020 were collected and analyzed.According to the established inclusion and exclusion criteria,102 patients with pancreatic cancer were finally included.The collected clinical data included patients’ basic data(age,gender,medical history),preoperative blood routine indexes,coagulation indexes,biochemical indexes,pathological examination results and follow-up information.The absolute values of neutrophils,monocytes,lymphocytes,fibrinogen and albumin were recorded,and SIRI and FAR were calculated respectively.The best truncation values of SIRI and FAR of this study data were calculated by the maximum Youden’s index of ROC curve.Patients with SIRI higher than 1.21 were in the high SIRI group,patients with less than or equal to 1.21 were in the low SIRI group,patients with FAR higher than0.119 were in the high FAR group,and patients with less than or equal to 0.119 were in the low FAR group.Combined SIRI and FAR to construct SIRI-FAR scoring system(S-F scores)to compare clinical data of each group.Univariate analysis was conducted to identify the risk factors affecting the prognosis of patients with pancreatic cancer after radical surgery,which were successively included in Cox proportional risk regression model for multivariate analysis to determine the independent risk factors affecting the prognosis and survival of patients with pancreatic cancer after surgery.Survival analysis was performed by Kaplan-Meier method for SIRI high-low group,FAR high-low group and S-F scores group,and comparison and verification of survival differences between groups were conducted by Log-Rank method.The relationship between SIRI-FAR combined or independent indicators and Overall Survival(OS)or Replapse Free Survival(RFS)of pancreatic cancer patients after radical surgery was analyzed.The predictive power of survival assessment was compared by comparing the area of under the ROC curve(AUC)of different inflammatory response-related indices.Results: Data of 102 patients undergoing radical resection of pancreatic cancer were collected in this study.The optimal threshold values were determined by SIRI and FAR according to ROC curve drawing,which were 1.21 and 0.119.High SIRI group versus low SIRI group,there were 46 cases(45.1%)in the high SIRI group and 56 cases(54.9%)in the low SIRI group.The difference between groups showed: There were statistically significant differences in pathological type,degree of differentiation,1-year OS,2-year OS,1-year RFS and 2-year RFS(P < 0.05),while there were no statistically significant differences in gender,age,BMI,history of diabetes,history of hypertension,history of coronary heart disease,tumor location,tumor diameter,surgical method,CA199,CA125 and CEA.High FAR group versus low FAR group,44 cases(43.1%)in the high FAR group and 58 cases(56.9%)in the low FAR group.Comparison of differences between groups showed that: There were statistically significant differences in pathological type,degree of differentiation,TNM stage,1-year OS,2-year OS,1-year RFS and 2-year RFS(P < 0.05),while there were no statistically significant differences in gender,age,BMI,history of diabetes,history of hypertension,history of coronary heart disease,tumor location,tumor diameter,surgical method,CA199,CA125 and CEA.According to the S-F scoring rule,among 102 patients who underwent radical surgery for pancreatic cancer,46 patients(45.1%)were assigned 0points,19 patients(18.6%)were assigned 1 points,and 37 patients(36.3%)were assigned 2 points.Comparison of differences among groups showed that: There were statistically significant differences in pathological type,degree of differentiation,TNM stage,1-year OS,2-year OS,1-year RFS and 2-year RFS(P < 0.05),but no statistically significant differences in age,BMI,history of diabetes,history of hypertension,history of coronary heart disease,tumor location,tumor diameter,surgical method,CA199,CA125 and CEA.COX univariate regression analysis showed that: gender,pathological type,degree of differentiation,TNM stage,CA199,CA125,SIRI,FAR and S-F scores were correlated with OS after radical resection of pancreatic cancer(P < 0.05).Gender,pathological type,degree of differentiation,TNM stage,SIRI,FAR and S-F score(P <0.05)were related factors affecting the relapse-free survival of patients after radical resection of pancreatic cancer.COX multivariate regression analysis showed that TNM stage(HR = 1.620,95%CI: 1.022-2.569,P,= 0.040),CA125(HR = 2.447,95%CI:1.435-4.172,P = 0.001),SIRI(HR = 3.466,95%CI: 1.924-6.243,P < 0.001),FAR(HR= 2.339,95%CI: 1.313-4.166,P = 0.004)and S-F scores(HR = 2.616,95%CI: 1.925-3.566,P < 0.001)were independent prognostic factors for postoperative OS of pancreatic cancer,TNM stage(HR = 1.672,95%CI: 1.069-2.614,P = 0.024),pathological type(HR = 2.181,95%CI: 1.093-4.352,P = 0.027),SIRI(HR = 2.904,95%CI: 1.651-5.109,P < 0.001),FAR(HR = 2.634,95%CI: 1.507-4.605,P < 0.001)and S-F score(HR = 2.566,95%CI: 1.919-3.432,P < 0.001)were independent prognostic factors for postoperative RFS of pancreatic cancer.K-M survival analysis and Log-Rank test analyzed the differences between groups with SIRI,FAR and S-F scores.Results showed that postoperative OS and RFS of pancreatic cancer patients with high SIRI,high FAR and high S-F scores before surgery were significantly decreased(P < 0.05).ROC curve was drawn,and the predictive efficacy of S-F score,SIRI,FAR and each clinicopathological index on 1-year OS,1-year RFS and 2-year RFS was compared according to AUC.The results showed that: Compared with TNM stage,differentiation degree and CA125,S-F score,SIRI and FAR have better evaluation value for postoperative survival of pancreatic cancer,and S-F score had best predictive efficacy.Conclusion(s): This study found that preoperative high SIRI,high FAR and high S-F score are independent risk factors affecting the prognosis of patients with pancreatic cancer after radical resection.All have a certain predictive value,and may be a supplement to the existing prognostic predictors. |
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