Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2024; 16(2): 386-397
Published online Feb 15, 2024. doi: 10.4251/wjgo.v16.i2.386
Systemic Inflammation Response Index and weight loss as prognostic factors in metastatic pancreatic cancer: A concept study from the PANTHEIA-SEOM trial
Vilma Pacheco-Barcia, Sara Custodio-Cabello, Fatima Carrasco-Valero, Magda Palka-Kotlowska, Axel Mariño-Mendez, Alberto Carmona-Bayonas, Javier Gallego, A J Muñoz Martín, Paula Jimenez-Fonseca, Luis Cabezon-Gutierrez
Vilma Pacheco-Barcia, Sara Custodio-Cabello, Magda Palka-Kotlowska, Luis Cabezon-Gutierrez, Department of Medical Oncology, Hospital Universitario de Torrejon, Madrid 28850, Spain
Fatima Carrasco-Valero, Department of Internal Medicine, Hospital Universitario de Torrejon, Madrid 28850, Spain
Axel Mariño-Mendez, Paula Jimenez-Fonseca, Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo 33011, Spain
Alberto Carmona-Bayonas, Department of Medical Oncology, Hospital Universitario Morales Meseguer, University of Murcia, Murcia 30001, Spain
Javier Gallego, Department of Medical Oncology, Hospital General Universitario de Elche, Elche 03202, Spain
A J Muñoz Martín, Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Universidad Complutense Madrid, Madrid 28007, Spain
Luis Cabezon-Gutierrez, Universidad Francisco de Vitoria, Madrid 28223, Spain
Author contributions: Pacheco-Barcia V, Mariño-Mendez A, and Jimenez-Fonseca P contributed to the conceptualization and project administration; Pacheco-Barcia V, Mariño-Mendez A, Jimenez-Fonseca P, and Cabezon-Gutierrez L were involved in the methodology and validation; Pacheco-Barcia V participated in the software, formal analysis, and data curation; Pacheco-Barcia V, Custodio-Cabello S, Carrasco-Valero F, Palka-Kotlowska M, Mariño-Mendez A, Carmona-Bayonas A, Gallego J, Martín AJM, Jimenez-Fonseca P, and Cabezon-Gutierrez L took part in the investigation of this study; Pacheco-Barcia V and Carrasco-Valero F contributed to the resources of this article; Pacheco-Barcia V, Jimenez-Fonseca P, and Cabezon-Gutierrez L wrote original draft; Pacheco-Barcia V, Carrasco-Valero F, and Jimenez-Fonseca P contributed to the writing, review and editing of this article; Custodio-Cabello S and Palka-Kotlowska M were involved in the visualization of this manuscript; Mariño-Mendez A, Jimenez-Fonseca P, and Cabezon-Gutierrez L participated in the supervision; and all authors have read and agreed to the published version of the manuscript.
Institutional review board statement: The study adhered to the ethical standards of the committee responsible for human experimentation (both institutional and national) and aligned with the 1975 Helsinki Declaration, as updated in 2008. The local ethics committee and Institutional Review Board approved the study under version 3.5, code PANT-SP-2023-01.
Informed consent statement: Consent was obtained from all patients who were alive at the time of data collection.
Conflict-of-interest statement: Pacheco-Barcia V: Advisory role: Advanced accelerator applications, a Novartis company. Speakers’ bureau: Merck, Eli Lilly, Eisai, Pierre Fabre. Congress attendance: Merck, Amgen, Merck Sharp and Dhome, Nutricia. Grant support: FSEOM and Merck. Other: Amgen. Martín AJM: Consultant or advisory role: GSK, Sanofi, Pfizer-BMS, Celgene, Leo Pharma, Incyte, Astra Zeneca, MSD, Lilly, Servier, Bayer, Roche. Research funding: Leo Pharma, Sanofi, Celgene. Speakers’ bureau: Rovi, Bayer, Menarini, Stada, Daichii Sankyo. Patents, Royalties. Other intellectual property: Risk assessment model in venous thromboembolism in cancer patients. Other authors declare no conflicts of interest related to this study.
Data sharing statement: Data supporting reported results can be requested from the authors.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vilma Pacheco-Barcia, MD, MSc, PhD, Doctor, Department of Medical Oncology, Hospital Universitario de Torrejon, C/Mateo Inurria S/N, Madrid 28850, Spain. vepacheco@torrejonsalud.com
Received: October 26, 2023
Peer-review started: October 26, 2023
First decision: December 2, 2023
Revised: December 14, 2023
Accepted: January 10, 2024
Article in press: January 10, 2024
Published online: February 15, 2024
Abstract
BACKGROUND

The prognostic value of the Systemic Inflammation Response Index (SIRI) in advanced pancreatic cancer is recognized, but its correlation with patients´ nutritional status and outcomes remains unexplored.

AIM

To study the prognostic significance of SIRI and weight loss in metastatic pancreatic cancer.

METHODS

The PANTHEIA-Spanish Society of Medical Oncology (SEOM) study is a multicentric (16 Spanish hospitals), observational, longitudinal, non-interventional initiative, promoted by the SEOM Real World-Evidence work group. This pilot study sought to analyze the association between weight loss and inflammatory status as defined by SIRI. The cohort stems from a proof-of-concept pilot study conducted at one of the coordinating centers. Patients with pathologically confirmed metastatic pancreatic adenocarcinoma, treated from January 2020 to January 2023, were included. The index was calculated using the product of neutrophil and monocyte counts, divided by lymphocyte counts, obtained within 15 days before initiation chemotherapy. This study evaluated associations between overall survival (OS), SIRI and weight loss.

RESULTS

A total of 50 patients were included. 66% of these patients were male and the median age was 66 years. Metastasis sites: 36% liver, 12% peritoneal carcinomatosis, 10% lung, and 42% multiple locations. Regarding the first line palliative chemotherapy treatments: 50% received gemcitabine plus nab-paclitaxel; 28%, modified fluorouracil, leucovorin, irinotecan and oxaliplatin, and 16% were administered gemcitabine. 42% had a weight loss > 5% in the three months (mo) preceding diagnosis. 21 patients with a SIRI ≥ 2.3 × 103/L exhibited a trend towards a lower median OS compared to those with a SIRI < 2.3 × 103/L (4 vs 18 mo; P < 0.000). Among 21 patients with > 5% weight loss before diagnosis, the median OS was 6 mo, in contrast to 19 mo for those who did not experience such weight loss (P = 0.003). Patients with a weight loss > 5% showed higher SIRI levels. This difference was statistically significant (P < 0.000). For patients with a SIRI < 2.3 × 103/L, those who did not lose > 5% of their weight had an OS of 20 mo, compared to 11 mo for those who did (P < 0.001). No association was found between carbohydrate antigen 19-9 levels ≥ 1000 U/mL and weight loss.

CONCLUSION

A higher SIRI was correlated with decreased survival rates in patients with metastatic pancreatic cancer and associated with weight loss. An elevated SIRI is suggested as a predictor of survival, emphasizing the need for prospective validation in the upcoming PANTHEIA-SEOM study.

Keywords: Pancreatic cancer, Nutrition, Prognostic factor, Inflammation, Advanced cancer, Systemic inflammatory response index, Weight loss

Core Tip: Advancements in the therapeutic landscape for pancreatic cancer have been modest in the recent years and the prognostic potential of the Systemic Inflammation Response Index (SIRI) in advanced pancreatic cancer has garnered interest. Originating from the PANTHEIA-Spanish Society of Medical Oncology (SEOM) initiative, a multicentric, observational, study promoted by the SEOM Real World-Evidence work group, our pilot research seeks to bridge this knowledge gap. Specifically, we focused on the interplay between weight loss and the inflammatory state as demarcated by SIRI. A significant correlation between elevated SIRI levels and decreased survival in patients with metastatic pancreatic cancer, with a notable association with weight loss, was observed.