Clinical Significance of Glucose to Lymphocyte Ratio (GLR) as a Prognostic Marker for Patients With Pancreatic Cancer

Abstract

Glucose metabolism and systemic inflammation have been associated with cancer aggressiveness and patient prognosis in various malignancies. This study aimed to evaluate the prognostic significance of pretreatment GLR(glucose to lymphocyte ratio) and systemic immune inflammation in patients with pancreatic cancer. We studied 360 patients with pathologically diagnosed pancreatic adenocarcinoma that was clinically unresectable. Baseline clinicopathological characteristics and laboratory investigations including fasting blood glucose, platelet count, lymphocyte count, neutrophil count, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA199), and follow-up data were collected for further analysis. The patients were randomly divided into a training cohort (n = 238) and a validation cohort (n = 122). Univariate and multivariate Cox proportional hazard regression analyses were performed to identify the prognostic value of GLR, systemic immune-inflammation markers, and tumor biomarkers. A nomogram model was developed based on the identified prognostic factors, and we used the C-index to evaluate the accuracy of the Cox regression model prediction. Multivariate analysis revealed that GLR [hazard ratio (HR): 2.597; 95% confidence interval (CI): 1.728-3.904)] and CA199 (HR: 2.484; 95% CI: 1.295-4.765) are independent predictors of poor overall survival in the training cohort and were incorporated into the nomogram for OS as independent factors. Moreover, the C-index analyses demonstrated that the C-indexes in the training cohort and the validation cohort were 0.674 and 0.671, respectively. The nomogram model predicts overall survival relatively accurately. We found that the baseline GLR is an independent prognostic factor for patients with pancreatic cancer, and the proposed nomogram can be used as an effective tool for predicting the outcomes of prognosis of patients with pancreatic cancer.

Adaptive Mechanisms of Tumor Therapy Resistance Driven by Tumor Microenvironment

“…Cytotoxic CD8 + T cells (CTLs) are the primary lymphocytes for killing tumor cells. They secrete cytotoxic enzymes including perforin and granzyme, and can interact with the major histocompatibility complex I (MHC-I) ( Tanaka et al, 1999 ; Jackaman et al, 2012 ; Martínez-Lostao et al, 2015 ; Wei et al, 2018 ; Zhong et al, 2020 ). The involvement of CTLs in tumor therapeutic resistance is proven by the strong association between the profile of CTLs in tumors and the chemotherapy outcomes ( Figure 3 ) ( Denkert et al, 2010 ; Halama et al, 2011 ; Chen and Chang, 2019 ).…”

Prognostic Value of Glucose-to-Lymphocyte Ratio in Critically Ill Patients with Acute Pancreatitis

“…Another study indicated that GLR is associated with prognosis in pancreatic cancer patients. 25 Moreover, Navarro et al 26 revealed that GLR is a prognostic marker in patients with resected pT2 gallbladder cancer. As far as we know, the present study verified that GLR is an independent prognostic marker to predict outcome in critically ill patients with AP according to the results of multivariate Cox regression analysis.…”

Prognostic value of preoperative glucose to lymphocytes ratio in patients with resected gastric cancer

“…CAR and NLR are inflammatory response markers that effectively predict the prognosis in various cancers [13][14][15]. Zhong et al stated that GLR has an essential role in determining the prognosis in pancreatic cancer patients, and that GLR alone is more effective in determining the average overall survival than NLR and CAR [12]. In another study, CAR and NLR were shown to have strong prognostic predictive values for gastric cancer [16].…”

“…An increase in the rate of glucose-lymphocyte ratio (GLR) due to hyperglycemia and immunosuppression is expected in cancer patients. The ratio of preoperative blood glucose level and lymphocyte counts significantly predicts prognosis in pancreatic cancers [12]. There is still a need for a more accurate and comprehensive assessment system with improved sensitivity and specificity for the assessment of prognosis.…”