Association of Immunologic Markers With Survival in Upfront Resectable Pancreatic Cancer
In a research letter published in JAMA Surgery, Tang et al found that higher levels of intratumoral CD3-positive T cells and postoperative circulating monocyte counts were associated with improved survival in patients with upfront resectable pancreatic ductal adenocarcinoma.
The prospective cohort study involved 63 adult patients who underwent upfront resection from June 2010 to November 2014 at Providence Portland Cancer Center. Patients had a median age of 67 years, and 57% were male. The median overall survival was 19.7 months. Immunologic markers and other clinicopathologic variables were assessed for associations with overall survival.
Immunologic Markers and Survival
Analysis of preoperative peripheral blood populations in 50 patients did not show any significant association with survival. A trend toward poorer survival was observed for higher monocyte levels (hazard ratio [HR] for death = 1.68, P = .15).
No associations were observed between peripheral blood populations and levels of intratumoral CD3-positive, CD8-positive, or CD68-positive cells. Analysis of tumor infiltrates in 53 patients showed a significant association between increased CD3-positive cell levels and overall survival (HR = 0.27, P = .04) and no associations with CD68-positive or CD8-positive cells.
Postoperative peripheral blood analysis in 41 patients showed that increasing monocyte count was associated with improved survival (HR = 0.34, P <.001), with a near significant association for CD4-positive cells (HR = 0.45, P = .06). On multivariate analysis, CD3-positive cell tumor infiltrate (HR = 0.18, P = .04) and postoperative circulating monocytes (HR = 0.44, P = .03) remained significant predictors, along with lymphovascular invasion and disease stage.
The investigators concluded, “[H]igher levels of tumor-infiltrating CD3+ T cells and higher postoperative circulating levels of monocytes were associated with an improved prognosis. These data suggest that, although peripheral blood immunocytes do not reflect the immune environment of the tumor, consideration of the systemic immune response during recovery from resection may be of value. Our data suggest a possible role for the patient’s immune response on the outcome of pancreatic tumor resection and that interventions that change the tumor immune environment and the systemic response in the postresection period could influence patient outcomes.”
Michael J. Gough, PhD, of the Integrated Therapies Laboratory at Providence Portland Medical Center, is the corresponding author for the JAMA Surgery article.
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