Chemotherapy-Induced Reduction of Neutrophil-to-Lymphocyte Ratio Is Associated With Better Survival in Pancreatic Adenocarcinoma: A Meta-Analysis

Abstract

Objectives: Numerous studies have suggested that an increase in neutrophil-to-lymphocyte ratio (NLR) before treatment is associated with worse survival in pancreatic adenocarcinoma (PAC). The aim of this study was to investigate the prognostic value of treatment-induced NLR change among PAC patients so as to better identify the characteristics of those who can benefit more from treatment. Methods: This meta-analysis was undertaken using the PRISMA statement. Previously published studies between the correlation of NLR change and patients’ survival were searched in Pubmed, Embase, and Web of Science databases. RevMan 5.3 was used to conduct statistical analysis. Results: A total of 1213 patients with PAC from 6 retrospective studies were included in this meta-analysis. Four studies investigated the HR of pre-treatment NLR, demonstrating its prognostic impact on overall survival (OS) (HR = 2.21, 95%CI: 1.45-3.36). One study reported that an elevated post-treatment NLR was associated with poorer OS (HR = 1.28, 95%CI = 1.08-1.52). Pooled analysis indicated that NLR reduction might predict favorable survival in both the overall population (HR = 1.52, 95% CI: 1.34–1.73) and the subgroup treated with chemotherapy (HR = 1.50, 95% CI: 1.32-1.70). Conclusion: Treatment-induced NLR change can act as an early predictor for PAC. Patients with reduced NLR after chemotherapy are expected to have better survival.

The rest period between chemotherapy and immunotherapy influences the efficacy of immune checkpoint inhibitors in lung cancer

“… 17 A meta‐analysis reported that chemotherapy‐induced reduction of NLR is associated with better survival in pancreatic cancer. 18 In other words, the immune cell status just before immunotherapy is important for the efficacy of ICIs.…”

“…It has been reported that prepembrolizumab NLR predicts the efficacy of second‐line pembrolizumab in urothelial cancer regardless of prechemotherapy NLR 17 . A meta‐analysis reported that chemotherapy‐induced reduction of NLR is associated with better survival in pancreatic cancer 18 . In other words, the immune cell status just before immunotherapy is important for the efficacy of ICIs.…”

“…It has been reported that chemotherapy changes the neutrophil‐lymphocyte ratio (NLR) of patients after urothelial cancer and pancreatic cancer treatment, affecting the efficacy of the next treatment and prognosis. 17 , 18 The NLR, a predictive and prognostic marker in various cancers, may be changed by cytotoxic chemotherapy. This change may also affect the efficacy of subsequent immunotherapy but is yet to be elucidated.…”

“…Changes in the immune cell population are different for each patient, even with the same drug. It has been reported that chemotherapy changes the neutrophil‐lymphocyte ratio (NLR) of patients after urothelial cancer and pancreatic cancer treatment, affecting the efficacy of the next treatment and prognosis 17,18 . The NLR, a predictive and prognostic marker in various cancers, may be changed by cytotoxic chemotherapy.…”

Neutrophil‑to‑lymphocyte ratio is associated with sensitivity to platinum‑based chemotherapy and prognosis in patients with advanced serous ovarian carcinoma

“…The NLR has therefore been considered a novel prognostic indicator (30,31). It is also reportedly associated with the responses of several cancers to chemotherapy (32)(33)(34)(35), indicating it potentially has value as a biomarker for predicting sensitivity to chemotherapy. Blood cell counts are routinely checked at the beginning of diagnosis or treatment, making the NLR a convenient, cost-effective, and reproducible marker in clinical practice.…”