Clinical Implications of Naples Prognostic Score in Patients with Resected Pancreatic Cancer

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FIGURE LEGENDS

Figure 1.

A, Kaplan-Maier curves of overall survival for each NPS group. B, Kaplan-Maier

curves of recurrence-free survival for each NPS group.

Supplementary Figure 1.

Calculation of the Naples prognostic score.

Supplementary Figure 2.

10

Kaplan-Maier curves of overall survival and recurrence-free survival in patients

without adjuvant chemotherapy.

Supplementary Figure 3.

Kaplan-Maier curves of overall survival and recurrence-free survival in patients

15

with adjuvant chemotherapy.

Supplementary Figure 4.

28

Receiver operating characteristic curves of the prognostic indicators.

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TABLE 1. Patient Characteristics

Variables

64.2 ± 10.3

Age, mean ± SD (years)

Sex

Male

126 (64.3%)

Female

70 (35.7%)

21.6 ± 3.17

Body mass index, mean ± SD

Tumor location

Head

147 (75.0%)

Body or tail

49 (25.0%)

Operative procedure

PD

60 (30.6%)

PPPD

15 (7.7%)

SSPPD

63 (32.2%)

DP

45 (22.9%)

TP

11 (5.6%)

Others

2 (1.0%)

UICC stage

IA

6 (3.1%)

IB

2 (1.0%)

IIA

57 (29.1%)

IIB

108 (55.1%)

III

2 (1.0%)

IV

21 (10.7%)

72 (36.7%)

Adjuvant chemotherapy

S-1

38 (19.4%)

GEM

18 (9.2%)

GS

4 (2.0%)

Others

12 (6.1%)

Naples prognostic score

Group 0

22 (11.2%)

Group 1

113 (57.7%)

30

61 (31.1%)

Group 2

PD; Pancreaticoduodenectomy, PPPD; Pylorus-preserving pancreaticoduodenectomy,

SSPPD;

Subtotal

stomach-preserving

pancreaticoduodenectomy,

DP;

Distal

pancreatectomy, TP; Total pancreatectomy, GEM; Gemcitabine, GS; Gemcitabine + S-1

31

TABLE 2. Association of Naples Prognostic Score and Clinicopathological Characteristics in 196

Patients with Resected Pancreatic Cancer

Variables

Age, years

Group 0

Group 1

Group 2

(n = 22)

(n = 113)

(n = 61)

61.1 ± 9.8

64.6 ± 10.1

64.6 ± 10.7

0.3281

0.0168*

Sex

Male

8 (36.4)

75 (67.6)

41 (67.2)

Female

14 (63.6)

36 (32.4)

20 (32.8)

20.4 ± 0.96

21.5 ± 0.41

20.7 ± 0.63

Body mass index

P value

0.4034

0.0022*

Tumor Location

Head

13 (59.1)

77 (69.4)

55 (90.2)

Body or tail

9 (40.9)

34 (30.6)

6 (9.8)

0.1302

CA19-9

≤ 37 IU/ml

10 (45.5)

29 (25.7)

46 (75.4)

> 37 IU/ml

12 (54.5)

84 (74.3)

15 (24.6)

0.6825

Tumor Size

≤ 20 mm

7 (31.8)

31 (27.4)

14 (22.9)

> 20 mm

15 (68.2)

82 (72.6)

47 (77.1)

0.0121*

Serosa invasion

(+)

13 (59.1)

90 (79.7)

54 (88.5)

(-)

9 (40.9)

23 (20.3)

7 (11.5)

0.0608

Retroperitoneum invasion

(+)

19 (86.4)

99 (87.6)

45 (73.8)

(-)

3 (13.6)

14 (12.4)

16 (26.2)

<.0001*

Bile duct invasion

(+)

7 (31.8)

46 (40.7)

44 (72.1)

(-)

15 (68.2)

67 (59.3)

17 (27.9)

<.0001*

Duodenum invasion

(+)

6 (27.3)

36 (31.9)

40 (65.6)

(-)

16 (72.7)

77 (68.1)

21 (34.4)

0.3431

Portal venous system invasion

(+)

8 (36.4)

46 (40.7)

18 (29.5)

(-)

14 (63.6)

67 (59.3)

43 (70.5)

0.7926

Regional artery invasion

(+)

2 (9.1)

13 (11.5)

5 (8.3)

(-)

20 (90.1)

100 (88.5)

55 (91.7)

32

0.6995

Nerve plexus invasion

(+)

3 (13.6)

20 (17.7)

13 (21.3)

(-)

19 (86.4)

93 (82.3)

48 (78.7)

0.7959

Lymphatic invasion

(+)

19 (90.5)

90 (84.9)

44 (86.3)

(-)

2 (9.5)

16 (15.1)

7 (13.7)

0.9006

Venous invasion

(+)

12 (57.1)

64 (60.4)

29 (56.9)

(-)

9 (42.9)

42 (39.6)

22 (43.1)

0.1349

Perineural invasion

(+)

17 (80.9)

88 (83.0)

48 (94.1)

(-)

4 (19.1)

18 (17.0)

3 (5.9)

0.099

Lymph node metastasis

(+)

11 (50.0)

79 (71.2)

45 (73.8)

(-)

11 (50.0)

32 (28.8)

16 (26.2)

0.3743

Peritoneal cytology

(+)

3 (13.6)

17 (15.0)

14 (22.9)

(-)

19 (86.4)

96 (85.0)

47 (77.1)

0.8913

UICC stage

I or II

III or IV

20 (90.9)

99 (87.6)

54 (88.5)

2 (9.1)

14 (12.4)

7 (11.5)

0.0989

Residual tumor

R1

2 (9.1)

30 (27.3)

20 (32.8)

R0

20 (90.9)

80 (72.7)

41 (67.2)

8 (36.3)

30 (26.5)

18 (29.5)

Adjuvant chemotherapy

CA19-9; Carbohydrate antigen 19-9, *; Statistically significant

33

0.6353

TABLE 3. Univariate and Multivariate Cox Proportional-hazard Regression Analysis of Overall Survival of Patients

Univariate analysis

Variables

Multivariate analysis

HR (95% CI)

P value

HR (95% CI)

P value

Age (≥ 70 years vs. < 70 years)

1.21 (0.79-1.83)

0.3667

Sex (male vs. female)

0.78 (0.52-1.16)

0.2166

Tumor location (head vs. body or tail)

1.23 (0.80-1.95)

0.3552

Tumor size (≤ 20 mm vs. > 20 mm)

0.48 (1.31-3.52)

0.0014

1.12 (0.66-1.96)

0.6795

Serosa invasion (+ vs. -)

1.13 (0.72-1.83)

0.5969

Retroperitoneum invasion (+ vs. -)

0.91 (0.57-1.52)

0.7024

Bile duct invasion (+ vs. -)

1.55 (1.05-2.30)

0.0261

1.03 (0.65-1.64)

0.9076

Duodenum invasion (+ vs. -)

1.41 (0.95-2.07)

0.0891

Portal venous system invasion (+ vs. -)

2.24 (1.52-3.31)

<.0001

1.94 (1.23-3.08)

0.0046*

Regional artery invasion (+ vs. -)

1.97 (1.05-3.41)

0.0359

0.78 (0.39-1.46)

0.4504

Nerve plexus invasion (+ vs. -)

2.04 (1.26-3.20)

0.0047

1.26 (0.70-2.20)

0.4335

Lymphatic invasion (+ vs. -)

3.39 (1.68-8.09)

0.0002

1.75 (0.77-4.55)

0.1883

Venous invasion (+ vs. -)

1.86 (1.25-2.84)

0.0023

0.96 (0.60-1.57)

0.8820

Perineural invasion (+ vs. -)

3.64 (1.73-9.36)

0.0002

1.58 (0.67-4.37)

0.3112

Lymph node metastasis (+ vs. -)

2.71 (1.68-4.60)

<.0001

1.99 (1.18-3.53)

0.0096*

Peritoneal cytology (+ vs. -)

1.93 (1.15-3.09)

0.0146

1.83 (1.06-3.05)

0.0305*

UICC stage (III or IV vs. I or II)

2.75 (1.61-4.46)

0.0004

1.39 (0.76-2.44)

0.2786

Residual tumor (R1 vs. R0)

2.14 (1.37-3.26)

0.0011

1.55 (0.93-2.53)

0.0942

CA19-9 (≥ 37 IU/ml vs. < 37 IU/ml)

1.37 (0.88-2.19)

0.1690

34

Adjuvant chemotherapy (- vs. +)

2.66 (1.75-4.16)

<.0001

2.71 (1.75-4.29)

<.0001*

NPS (Grade 2 vs. Grade 0/1)

1.73 (1.14-2.59)

0.0109

1.82 (1.15-2.84)

0.0104*

CA19-9; Carbohydrate antigen 19-9; NPS; Naples prognostic score, *; Statistically significant

35

TABLE 4. Association of Naples Prognostic Score and Surgical Outcome

Grade 0

Grade 1

Grade 2

(n = 22)

(n = 113)

(n = 61)

Operative time (min)

384.7 ± 28.9

423.8 ± 12.9

457.9 ± 17.4

Estimated blood loss (ml)

822.4 ± 200.1 1009.4 ± 89.1 1159.9 ± 120.2

P value

0.0755

0.3201

Postoperative complications (CD ≥ Ⅲ)

8 (38.1)

43 (40.6)

17 (33.3)

0.6828

ISGPF grade ≥ B

6 (28.6)

25 (23.6)

8 (15.7)

0.5167

Bile leakage

0 (0)

1 (0.9)

3 (5.8)

0.1124

Intra-abdominal bleeding

0 (0)

3 (2.8)

1 (1.9)

0.7168

Delayed gastric emptying

1 (4.8)

12 (11.3)

7 (13.7)

0.5488

Infectious complications

1 (4.8)

11 (10.4)

8 (15.7)

0.3728

Portal vein thrombosis

1 (4.8)

3 (2.8)

1 (1.9)

0.8074

34.8 ± 5.5

37.8 ± 2.5

37.4 ± 3.5

0.8806

Postoperative hospital stay (day)

CD; Clavien-Dindo grade, ISGPF; International Study Group for Pancreatic Fistula

...