Yonsei Med J.  2020 Apr;61(4):291-300. 10.3349/ymj.2020.61.4.291.

Yonsei Criteria, a Potential Linkage to Intratumoral Foxp3⁺/CD8⁺ Ratio for the Prediction of Oncologic Outcomes in Resected Left-Sided Pancreatic Cancer

Affiliations
  • 1Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. cmkang@yuhs.ac
  • 2Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea.
  • 3Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
  • 4Department of Gastrointestinal Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 5Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 6Department of Pharmacy, Yonsei University College of Pharmacy, Seoul, Korea.

Abstract

PURPOSE
This study sought to investigate associations among Yonsei criteria (tumor confined to the pancreas, intact fascia layer between the distal pancreas and the left adrenal gland and kidney, and tumor located more than 1-2 cm from the celiac axis) and tumor infiltrating lymphocytes in pancreatic cancer.
MATERIALS AND METHODS
Patients who underwent curative distal pancreatectomy due to left-sided pancreatic cancer from January 2000 to December 2011 were enrolled. Follow-up was completed September 30, 2015.
RESULTS
Fifty patients were enrolled. Having ≥ two metastatic lymph nodes (LNs, p=0.002), intraoperative transfusion (p=0.011), low levels of tumor infiltrating CD8⁺ T-cells (p=0.001), and a high Foxp3⁺/CD8⁺ ratio (p=0.009) were independent risk factors for disease-free survival. Not satisfying the Yonsei criteria (p=0.021), having ≥ two metastatic LNs (p=0.032), low levels of tumor infiltrating CD8⁺ T-cells (p=0.040) and a high Foxp3⁺/CD8⁺ ratio (p=0.032) were associated with unfavorable overall survival. High levels of CA19-9 and not satisfying the Yonsei criteria were significantly associated with a high Foxp3⁺/CD8⁺ ratio [Exp(β)=3.558; 95% confidence inverval: 1.000-12.658; p=0.050].
CONCLUSION
Yonsei criteria may be clinically detectable biologic marker with which to predict immunologic status and survival in pancreatic cancer patients.

Keyword

Pancreatic cancer; tumor infiltrating lymphocyte; cytotoxic T lymphocyte; regulatory T lymphocyte

MeSH Terms

Adrenal Glands
Biomarkers
Disease-Free Survival
Fascia
Follow-Up Studies
Humans
Kidney
Lymph Nodes
Lymphocytes, Tumor-Infiltrating
Pancreas
Pancreatectomy
Pancreatic Neoplasms*
Risk Factors
T-Lymphocytes
Biomarkers
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