preprints.org > medicine and pharmacology > gastroenterology and hepatology > doi: 10.20944/preprints202411.0056.v1 (registering DOI)

Preprint Article Version 1 This version is not peer-reviewed

Version 1 : Received: 1 November 2024 / Approved: 1 November 2024 / Online: 1 November 2024 (14:00:38 CET)

Objective: This study investigates the prognostic significance of lymph node ratio (LNR) and CA 19-9 levels on survival outcomes in patients with resected pancreatic adenocarcinoma, with the goal of refining risk stratification and guiding treatment strategies. Methods: A retrospective cohort of 123 patients with histopathologically confirmed pancreatic adenocarcinoma who underwent surgical resection was analyzed. Demographic, tumor-specific, and laboratory data, including LNR and CA 19-9 levels, were collected. ROC analysis was performed to establish optimal cut-off points, and Kaplan-Meier survival analysis was used to evaluate survival distributions across groups defined by LNR and CA 19-9 values. Results: The cohort's median survival was 22 months, with a mean survival time of 45.36 ± 4.80 months. Patients with a positive LNR > 0.14 exhibited significantly shorter survival (median: 17 months) compared to those with an LNR ≤ 0.14 (median: 30.2 months, p = 0.001). ROC analysis confirmed LNR > 0.14 as an optimal cut-off for predicting mortality, with an area under the curve (AUC) of 0.646 (p = 0.007), sensitivity of 88.2%, and specificity of 42.7%. CA 19-9 levels were also predictive of survival outcomes: patients with CA 19-9 levels ≥ 39 U/mL had a median survival of 17 months, significantly shorter than the 29-month median survival observed in patients with CA 19-9 < 39 U/mL (p = 0.034). Mortality rates were notably higher in patients with elevated CA 19-9 levels (78.4% vs. 63.3%). Combining both markers, patients with an LNR > 0.14 and CA 19-9 ≥ 39 U/mL demonstrated the poorest survival, with a cumulative survival rate of 0% by the 60th month. In contrast, those with LNR ≤ 0.14 and CA 19-9 < 39 achieved a cumulative survival rate of 33.6% at the 73rd month. This combined marker approach revealed statistically significant survival differences, underscoring the utility of using LNR and CA 19-9 jointly to stratify risk and predict outcomes (p < 0.001). Conclusion: LNR and CA 19-9 levels are significant independent predictors of survival in pancreatic adenocarcinoma. Elevated values in either marker correlate with reduced survival, while combining both enhances prognostic accuracy. Integrating these biomarkers into clinical evaluations could enable more effective risk stratification and guide therapeutic decisions, particularly for patients who may benefit from more aggressive treatment approaches.

Pancreatic adenocarcinoma; Lymph node ratio (LNR); CA 19-9; Prognostic markers; Survival analysis

Medicine and Pharmacology, Gastroenterology and Hepatology

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