The clinical utility of nutritional and immunological indices as prognostic factors in pancreatic cancer after pancreatectomy

BACKGROUND: Pancreatic cancer (PC) exhibits aggressive malignant behavior and is the most lethal cancer type worldwide. It is often accompanied by malnutrition, which exacerbates as the disease progresses. We investigated the clinical utility of nutritional and immunological indices as prognostic factors in patients with PC using five major nutritional indices: the Controlling Nutritional Status (CONUT) score, C-reactive protein/albumin ratio, neutrophil/lymphocyte ratio, platelet-to-lymphocyte ratio, and Prognostic Nutritional Index. METHODS: We retrospectively analyzed 328 patients with PC who underwent R0 pancreatectomy at Kumamoto University Hospital between 2004 and 2023. RESULTS: Among the evaluated indices, CONUT-High (score ≥3) was the most significant poor prognostic factor for overall survival (OS; P = 0.039) and recurrence-free survival (RFS; P = 0.013) post-pancreatectomy. Among clinicopathological factors, CONUT-High was independently associated with poorer RFS (hazard ratio [HR]: 1.35, P = 0.034) but was not significant for OS (HR: 1.30, P = 0.088). Even in patients with carbohydrate antigen 19-9 (CA19-9)-negative PC, the CONUT score remained a useful prognostic factor for OS (HR: 1.64, P = 0.0496) and RFS (HR: 1.68, P = 0.024). In the 1:1 propensity score matching analysis, CONUT-High was identified as an independent poor prognostic factor for RFS (HR: 1.50, P = 0.021), but not OS (HR: 1.43, P = 0.063). CONCLUSION: The CONUT score may serve as a simple, independent prognostic factor for RFS in PC, regardless of CA19-9 elevation.