title: The relationship between tumor inflammatory cell infiltrate and outcome in patients with pancreatic ductal adenocarcinoma.
abstract: BACKGROUND
  The tumor-associated inflammatory cell infiltrate is recognized to have prognostic value in various common solid tumors. However, the prognostic value of the tumor inflammatory cell infiltrate has not been established in pancreatic ductal adenocarcinoma (PDAC) nor has its relationship with the systemic inflammatory response.
  
  
  METHODS
  Retrospective study was made of 173 patients who underwent surgery between 1997 and 2009. Routine pathology specimens were scored according to density of the tumor inflammatory cell infiltrate, and biochemical data were collected preoperatively.
  
  
  RESULTS
  Low-grade tumor inflammatory cell infiltrate was associated with earlier tumor recurrence (P < 0.001) and particularly in the liver (P = 0.027). It was also associated with T3 tumors (P < 0.05), lymph node involvement (P < 0.05), and resection margin involvement (P < 0.05). On univariate survival analysis, age <65 years (P < 0.05), mGPS (P < 0.001), increased tumor stage (P < 0.01), nodal involvement (P < 0.01), size (P < 0.05), grade (P < 0.05), perineural invasion (P < 0.05), venous invasion (P < 0.01), resection margin involvement (P ≤ 0.001), vascular reconstruction (P < 0.05), and no adjuvant chemotherapy (P < 0.05) were associated with poor survival. In contrast, high-grade tumor inflammatory cell infiltrate was associated with better survival (P < 0.001). On multivariate survival analysis, mGPS [hazard ratio (HR): 1.77, 95% confidence interval (95% CI): 1.19-2.62, P = 0.005], tumor stage (HR: 2.21, 95% CI: 1.16-4.23, P = 0.016), resection margin involvement (HR: 2.19, 95% CI: 1.41-3.44, P = 0.001), venous invasion (HR: 1.79, 95% CI: 1.22-2.63, P = 0.003), tumor inflammatory cell infiltrate (HR: 0.37, 95% CI: 0.25-0.55, P = 0.0001), and adjuvant chemotherapy (P = 0.04) were independently prognostic.
  
  
  CONCLUSIONS
  The results of the study show, for the first time, that the presence of a high-grade tumor inflammatory cell infiltrate is an independent predictor of prolonged overall survival following resection for PDAC. Furthermore, measures of the local and the systemic inflammatory response were inversely associated.
authors.affiliation: West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom. nigeljamieson@yahoo.com
authors.forename: Nigel B
authors.initials: NB
authors.lastname: Jamieson
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mohamed
authors.forename: Karin A
authors.initials: KA
authors.lastname: Oien
authors.forename: Alan K
authors.initials: AK
authors.lastname: Foulis
authors.forename: Euan J
authors.initials: EJ
authors.lastname: Dickson
authors.forename: Clem W
authors.initials: CW
authors.lastname: Imrie
authors.forename: C Ross
authors.initials: CR
authors.lastname: Carter
authors.forename: Colin J
authors.initials: CJ
authors.lastname: McKay
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000628:therapy*; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D015588:Observer Variation; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome