Development of a Nomogram Integrating Modified Inflammation-Based Indexes for Predicting Overall Survival in...

Area of Science:

• Oncology
• Immunology
• Hepatology

Background:

• Pancreatic cancer (PCA) is a deadly malignancy with a poor prognosis.
• PCA is characterized by a cold, immunosuppressive tumor microenvironment.
• Liver dysfunction can alter inflammation indices, impacting immune status assessment.

Purpose of the Study:

• To refine inflammation indices by incorporating liver function indicators for improved prognostic prediction in PCA.
• To develop and validate a nomogram model for predicting overall survival (OS) in PCA patients.

Main Methods:

• Selected resected PCA cases were analyzed.
• Liver function indicators were integrated into covariance analysis to modify inflammation indices (mNLR, mPLR, mLMR, mSII, mCRP).
• A nomogram was developed and compared to a standard inflammation-based model using DCA and C-index.

Main Results:

• Higher modified neutrophil-to-lymphocyte ratio (mNLR) and modified systemic immune-inflammation index (mSII) correlated with worse OS.
• Higher modified lymphocyte-to-monocyte ratio (mLMR) and PNI levels correlated with better OS.
• The developed nomogram model demonstrated superior clinical utility compared to the primary inflammation-based model.

Conclusions:

• Modified inflammation indices, adjusted for liver function, enhance prognostic prediction in PCA.
• The nomogram incorporating these modified indices offers superior clinical utility for predicting OS.
• Recommendations include adjusting inflammation indices for liver function, especially in PCA with biliary obstruction, and considering nanoknife ablation and adjuvant chemotherapy for advanced cases.