Correlation of Prognostic Markers {CEA, Ca19.9, Neutrophil To Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR)} With Progression Free Survival (PFS) in Advanced/Metastatic Gallbladder Carcinoma.

ABSTRACT

Gallbladder carcinoma (GBC) is likely to be diagnosed at progressive stages and shows a very poor prognosis. Combination of gemcitabine and cisplatin (GEMCIS) has been widely used as first line palliative chemotherapy. Prognostic significance of inflammatory markers Neutrophil to lymphocyte ratio (NLR) and Platelet to lymphocyte ratio (PLR) in advanced gallbladder carcinoma (GBC) is not well established. MATERIAL: 30 patients who were diagnosed as advanced/ metastatic gallbladder carcinoma with age more than 18 years were included. All patients who were fit to receive chemotherapy was started on gemcitabine 1000mg/m2 and cisplatin 25mg/m2 (GEMCIS) administered intravenously on days 1 and 8 every 3 weeks. The treatment was repeated for a total of 6 cycles or until the occurrence of unacceptable toxicity, loss to follow up, confirmation of disease progression or death. All the patients underwent Contrast enhanced CT scan along with markers NLR, PLR, carcinoembryonic antigen (CEA), carbohydrate antigen 19.9 (CA19.9) at the baseline and at the end of 3 and 6 cycles of chemotherapy and the tumour response was assessed based on Response Evaluation Criteria in Solid Tumours RECIST 1.1 criteria. Progression free survival was calculated from the date of documentation of best response. The response was correlated with markers CEA, CA19.9, NLR and PLR. OBSERVATION At a cut-off of NLR (>3 ng/ml) and PLR (>190) predicts progression with a sensitivity of 91% and 100% respectively and both with a specificity of 100%. Out of 30 participants 11 (36.7%) had disease progression (p<0.001). Disease progression noted in 8 participants (26.7%) after 3 cycles (P<0.001) and in 3 participants (13.6%) after 6 cycles of chemotherapy (p <0.001). Disease control rate was 63.33% 01(3.3%) patient with complete response, 07(23.3%) patients with partial response, 11(36.7%) patients with stable disease. Mean progression free survival in participants associated with progressive disease was 11.45±5.54 weeks (p <0.001). Neutrophil to lymphocyte ratio (NLR) >3 (95%CI 7.6-13.6; log rank test P<0.01) and Platelet to lymphocyte ratio (PLR) >190 (95%CI 7.67-8.83; log rank test p<0.001) were significantly associated with worse progression free survival. CONCLUSION: Increased levels of NLR (>3) and PLR (>190) have prognostic value to predict progression free survival (PFS) in advanced gallbladder carcinoma patients on palliative chemotherapy. NLR and PLR can be used as prognostic markers in advanced gallbladder carcinoma.