Peripheral Blood Lymphocyte Percentage May Predict Chemotolerance and Survival in Patients with Advanced Pancreatic Cancer. Association between Adaptive Immunity and Nutritional State

• Published in: Current oncology (Toronto) Vol. 28; no. 5; pp. 3280 - 3296
• Main Authors: Aquilani, Roberto, Brugnatelli, Silvia, Maestri, Roberto, Boschi, Federica, Filippi, Beatrice, Perrone, Lorenzo, Barbieri, Annalisa, Buonocore, Daniela, Dossena, Maurizia, Verri, Manuela
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI 26-08-2021; MDPI AG
• Subjects: Adaptive Immunity; advanced pancreatic cancer; chemotolerance; Humans; impaired adaptive immune response; Lymphocytes; Nutritional Status; Pancreatic Neoplasms; Pancreatic Neoplasms - drug therapy; Prognosis; Retrospective Studies; survival; impaired adaptive immune response; nutritional status; chemotolerance; survival; advanced pancreatic cancer
• ISSN: 1718-7729; 1198-0052; 1718-7729
• DOI: 10.3390/curroncol28050285

Pancreatic Carcinoma (PC) cells have the ability to induce patient immunosuppression and to escape immunosurveillance. Low circulating lymphocytes are associated with an advanced stage of PC and reduced survival. Blood lymphocytes expressed as a percentage of Total White Blood Cells (L% TWBC) could predict chemotolerance (n° of tolerated cycles), survival time and Body Weight (BW) more effectively than lymphocytes expressed as an absolute value (L
> 1500 n°/mm
) or lymphocytes >22%, which is the lowest limit of normal values in our laboratory. Forty-one patients with advanced PC, treated with chemotherapy, were selected for this observational retrospective study. Patients were evaluated at baseline (pre-chemotherapy), and at 6, 12 and 18 months, respectively, after diagnosis of PC. The study found L ≥ 29.7% to be a better predictor of survival (COX model, using age, sex, BW, serum creatinine, bilirubin and lymphocytes as covariates), chemotolerance (r = +0.50,
= 0.001) and BW (r = +0.35,
= 0.027) than L
> 1500 or L > 22%. BW did not significantly correlate with chemotolerance or survival. The preliminary results of this study suggest that L ≥ 29.7% is more effective than L
> 1500 or L > 22% at predicting chemotolerance, survival time and nutritional status. A possible impact of nutritional status on chemotherapy and survival seems to be lymphocyte-mediated given the association between BW and L%. This study may serve as the basis for future research to explore whether nutritional interventions can improve lymphopenia, and if so, how this may be possible.