A novel scoring system to predict survival in patients with advanced pancreatic adenocarcinoma: The Memorial Prognostic Score (MPS).

36 Background: A major limitation of prognostic tools such as the Eastern Cooperative Oncology Group (ECOG), Karnofsky, and Palliative Performance Scale is a reliance on subjective clinical assessment. An objective tool, the Glasgow Prognostic Score (GPS) is derived from C-reactive Protein (CRP) and albumin and has been validated in patients with operable and inoperable malignancies. One disadvantage of this tool is that CRP is not routinely measured in the United States. We examined if the Neutrophil-Lymphocyte Ratios (NLR) (Ahn, H.K., et al., Neutrophil-Lymphocyte Ratio Predicts Survival in Terminal Cancer Patients. J Palliat Med, 2016) could be substituted for CRP in the GPS to predict survival in patients with advanced pancreatic adenocarcinoma.

METHODS: A retrospective chart review identified patients at MSKCC with pathology-confirmed stage IV pancreatic adenocarcinoma diagnosed between 2011 to 2014. Pre-treatment absolute neutrophil count, absolute lymphocyte count, and albumin were extracted. The NLR for each patient was calculated and assigned: NLR ≤ 4 g/dl = 0, NLR > 4 g/dl = 1; serum albumin > 4 g/dl = 0, and serum albumin < 4 g/dl = 1. Combining NLR and albumin scores resulted in a composite MPS score of 0-2, similar to GPS. We evaluated the association of the MPS with overall survival.

RESULTS: N = 833 patients were identified with median survivals summarized in the table below. A log-rank test showed statistically significant differences in survival between MPS groups (p<0.00005). The MPS on univariate analysis had a HR of 1.36 (95% CI 1.23 - 1.50, p<0.0005) associated with overall survival.

CONCLUSIONS: The MPS, a novel composite of NLR and albumin, is an objective prognostic tool that divided this sample of patients into three clinically distinct subgroups. Further interrogation will control for performance status, disease characteristics and anti-cancer therapy. [Table: see text].