title: Prognostic indicators based on inflammatory and nutritional factors after pancreaticoduodenectomy for pancreatic cancer.
abstract: OBJECTIVE
  We evaluated prognostic indicators based on inflammatory and nutritional factors, namely, the modified Glasgow Prognostic Score (mGPS), the Prognostic Nutritional Index (PNI), the neutrophil/lymphocyte ratio (NLR), and the platelet/lymphocyte ratio (PLR), to determine their efficiency and significance after pancreaticoduodenectomy for pancreatic cancer.
  
  
  METHODS
  The subjects of this study were 46 patients who underwent pancreaticoduodenectomy for pancreatic cancer between October 2007 and December 2014. Patients were divided into preoperative mGPS (0/1 and 2), PNI (<40 and ≥40), NLR (<2.5 and ≥2.5), and PLR (<200 and ≥200) groups, to evaluate various perioperative outcomes.
  
  
  RESULTS
  Hemoglobin concentrations were significantly lower (P = 0.019), whereas intra-abdominal bleeding was significantly higher (P = 0.040) in the PNI (<40) group than in the PNI (≥40) group. The incidence of postoperative pneumonia was significantly higher in the mGPS (2) group (P = 0.009), and surgical complications greater than grade 3 (Clavien-Dindo classification) were significantly increased in the NLR (≥2.5) group (P = 0.041). Overall survival rates in the PNI (<40) (P = 0.019), NLR (≥2.5) (P = 0.001), and PLR (≥200) (P < 0.001) groups were significantly lower than those in the other groups. The PLR was the only independent prognostic indicator (P = 0.002) according to multivariate analysis.
  
  
  CONCLUSIONS
  The mGPS, PNI, and NLR were effective predictive indicators of postoperative complications. The PLR was the most useful prognostic indicator for pancreatic cancer patients after pancreaticoduodenectomy.
authors: Division of Surgical Oncology, Department of Surgery, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan. watanabe.j@med.tottori-u.ac.jp.
authors: Joji
authors: J
authors: Watanabe
authors: Division of Surgical Oncology, Department of Surgery, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
authors: Shinji
authors: S
authors: Otani
authors: Division of Surgical Oncology, Department of Surgery, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
authors: Teruhisa
authors: T
authors: Sakamoto
authors: Division of Surgical Oncology, Department of Surgery, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
authors: Yosuke
authors: Y
authors: Arai
authors: Division of Surgical Oncology, Department of Surgery, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
authors: Takehiko
authors: T
authors: Hanaki
authors: Division of Surgical Oncology, Department of Surgery, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
authors: Masataka
authors: M
authors: Amisaki
authors: Division of Surgical Oncology, Department of Surgery, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
authors: Naruo
authors: N
authors: Tokuyasu
authors: Division of Surgical Oncology, Department of Surgery, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
authors: Soichiro
authors: S
authors: Honjo
authors: Division of Surgical Oncology, Department of Surgery, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
authors: Masahide
authors: M
authors: Ikeguchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils; D015596:Nutrition Assessment; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010976:Platelet Count; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate
keywords: Pancreatic cancer; Pancreaticoduodenectomy; Prognostic indicator