The association between pain and WHO grade of pancreatic neuroendocrine neoplasms: A multicenter study

Mechanism of LDH and IL-8 involved in pancreatic cancer pain and the correlation of pain degree

Background

This research aimed to observe the mechanism of lactate dehydrogenase (LDH) and interleukin 8 (IL8) in pancreatic cancer pain and their correlation with pain degree.

Methods

126 patients with pancreatic cancer who visited our hospital from January 2021 to February 2023 were selected. The patients were divided into groups of 58 patients with low pain (1~3 points) and 68 patients with high pain (4~10 points) by visual analog scale (VAS). And 50 health examinees in the same period were selected as the healthy control group. The serum LDH and IL-8 concentrations are analyzed by enzyme-linked immunosorbent assay, and the subjective pain grading method score is analyzed. The differences in LDH and IL-8 concentrations among the three groups of patients were compared. Pearson correlation analysis was used to investigate the correlation between LDH, IL-8 concentrations, and patient pain. Binary logistic regression was used to determine independent risk factors for high pain, and ROC curves were used to analyze the diagnostic efficacy of each indicator.

Results

The serum LDH and IL-8 concentrations in the high-pain group were exceed the low-pain group's (P<0.05). The serum LDH and IL-8 concentrations in the low-pain group exceeded the healthy control group's (P<0.05). Pearson correlation analysis revealed a positive correlation between serum LDH concentration and pain grading (r=0.736, P=0.000). The serum IL-8 positively correlates with pain grading (r=0.680, P=0.000). Serum LDH and IL-8 concentrations positively correlate (r=0.589, P=0.000). LDH and IL-8 concentrations are independent risk factors for high pain levels (OR=1.033, 1.142, P<0.05). The logistic regression prediction model formula was used: Y=constant+B1X1+B2X2+...+BnXn to set the joint diagnostic prediction model as -12.063+ 0.033×LDH+0.133×IL-8. The areas under the ROC curves of LDH, IL-8, and predictive model (LDH+IL-8) in patients with high pain were 0.925, 0.945, and 0.974, respectively. The relevant standards for LDH are >190 U/L, IL-8 is >36 pg/mL, and the relevant standards for prediction models are >5.75.

Conclusions

LDH and IL-8 participate in the pain aggravation process of pancreatic cancer and are closely related to the pain grading. The combination of LDH and IL-8 can be used as a biological indicator to evaluate the pain severity of pancreatic cancer and provide a reference for clinical diagnosis and treatment.

The association between jaundice and poorly differentiated pancreatic neuroendocrine neoplasms (Ki67 index > 55.0%)

BACKGROUND

Jaundice occurs in some pancreatic disease. However, its occurrences and role in pancreatic neuroendocrine neoplasms (PNENs) has not been well studied. In this study we showed the association between jaundice and the risk of high grade and poorly differentiated PNENs.

METHODS

Ninety-three patients with head-neck PNENs were included. Poorly differentiated pancreatic neuroendocrine neoplasms were defined by a ki67 index > 55.0%. Logistic regression was used to show the association between demographic information, clinical signs and symptoms and the risk of poorly differentiated tumors. A nomogram model was developed to predict poorly differentiated tumor.

RESULTS

Eight of 93 PNEN patients (8.6%) had jaundice. The age and ki67 index in patients with jaundice were significantly higher than those patients without jaundice. All jaundice occurred in patients with grade 3 PNENs. Mutivariable regression analysis showed that age (odds ratio(OR) = 1.10, 95% confidence interval (CI):1.02-1.19), tumor size (OR = 1.42, 95%CI:1.01-2.00) and jaundice (OR = 14.98, 95%CI: 1.22-184.09) were associated with the risk of poorly differentiated PNENs. The age and size combination showed a good performance in predicting poorly differentiated PNENs (area under the curve (AUC) = 0.81, 95% CI: 0.71-0.90). The addition of jaundice further improved the age- and size-based model (AUC = 0.86, 95% CI: 0.78-0.91). A nomogram was developed based on age, tumor size and jaundice.

CONCLUSION

Our data showed that jaundice was associated with the risk of high grade PNENs and poorly differentiated PNENs.