Estado inmuno-nutricional y cáncer de páncreas

Abstract

Pancreatic cancer, though rare, is a clinical entity of exceeding interest due to its high mortality (5-year survival of 5%), unresectability (80%) and surgical complexity (implying a rate of complications up to 30%). As it occurs in other tumours, genetic mutations are the initial event of carcinogenesis, followed by histological aberrations. Finally, the malignant cell obtains invasive and metastatic ability. Inflammation has been related with development and progression of neoplasms, based on different pathogenic routes in which macrophages and proinflammatory cytokines (IL-1, IL-6, TNFα) play a major role. Moreover, chronic and systemic inflammatory condition is associated with induction of hypercatabolism, general impairment and terminal cachexia that appear in oncologic patients. This condition generates remarkable abnormalities in blood analysis: increased acute-phase reactants (such as reactive C protein), hypoalbuminemia, elevated neutrophils and platelets, lymphopenia. Consequently, different indexes and scores have been defined in order to quantify and graduate inflammatory and nutritional condition (Neutrophil Lymphocyte Ratio, Platelet Lymphocyte Ratio, Glasgow Prognostic Score, Prognostic Nutritional Index). Several studies have observed that these scores correlate with survival among oncologic patients, in cluding those with pancreatic cancer. Besides, association between prediction of postoperative morbidity and inflammatory scores has also been studied, as well as suspicion of malignant evolution of some preneoplastic pancreatic lesions.