How can we better predict the prognosis of patients with pancreatic cancer undergoing surgery using an immune-nutritional scoring system?

BACKGROUND: Several immune-nutritional scores have been used to predict the prognosis of pancreatic cancer, but the efficacies of these scores have yet to be compared. This study aimed to compare various immune-nutritional scores and establish a more accurate scoring system to evaluate the prognosis of pancreatic cancer. METHODS: The preoperative immune-nutritional scores of 411 patients with pancreatic cancer who underwent radical surgery were retrospectively compared. The cut-off point for predicting mortality was determined using X-tile analysis. The efficacies of various immune-nutritional scores for predicting the short- and long-term outcomes of pancreatic cancer were compared. A new nomogram was established based on immune-nutritional scores. RESULTS: Regardless of the immune-nutritional scoring method, the short- and long-term outcomes of the group with better nutritional status were better than those of the other groups. The modified Glasgow prognosis score (C-index = 0.74) and controlling nutritional status score (C-index = 0.61) were more effective for predicting the prognosis of pancreatic cancer. A nomogram based on controlling nutritional status, red blood cell distribution, modified Glasgow prognosis score, and tumor node metastasis classification stage was more accurate than any single immune-nutritional score for predicting pancreatic cancer prognosis (C-index = 0.78). CONCLUSION: Patients with pancreatic cancer with poor preoperative nutritional status have a poorer prognosis. We identify a new nomogram based on immune-nutritional scores that provides an accurate and individualized prediction of prognosis for pancreatic cancer.