External Validation of the Derived Neutrophil to Lymphocyte Ratio as a Prognostic Marker on a Large Cohort of Pancreatic Cancer Patients

Abstract

BackgroundWith growing evidence on the role of inflammation in cancer biology, the presence of a systemic inflammatory response has been postulated as having prognostic significance in a wide range of cancer types. The derived neutrophil to lymphocyte ratio (dNLR), which represents an easily determinable potential prognostic marker in daily practise and clinical trials, has never been externally validated in pancreatic cancer (PC) patients.MethodsData from 474 consecutive PC patients, treated between 2004 and 2012 at a single centre, were evaluated retrospectively. Cancer-specific survival (CSS) was assessed using the Kaplan-Meier method. To evaluate the prognostic relevance of dNLR, univariate and multivariate Cox regression models were applied.ResultsWe calculated by ROC analysis a cut-off value of 2.3 for the dNLR to be ideal to discriminate between patients’ survival in the whole cohort. Kaplan-Meier curve reveals a dNLR≥2.3 as a factor for decreased CSS in PC patients (p<0.001, log-rank test). An independent significant association between high dNLR≥2.3 and poor clinical outcome in multivariate analysis (HR = 1.24, CI95% = 1.01–1.51, p = 0.041) was identified.ConclusionIn the present study we confirmed elevated pre-treatment dNLR as an independent prognostic factor for clinical outcome in PC patients. Our data encourage independent replication in other series and settings of this easily available parameter as well as stratified analysis according to tumor resectability.

Neutrophil/lymphocyte ratio helps select metastatic pancreatic cancer patients benefitting from oxaliplatin

“…NLR was confirmed to be an independent prognostic biomarker in multivariate analysis, together with tumor stage, grade, administration of chemotherapy and high CRP [31]. NLR cut-off was initially set at 5, according to the previous literature.…”

“…There was no imbalance in KPS between GEM and GEMOXA group (KPS 80 or 90 in 53% and 42% of patients, respectively, chi-square p value = 0.209). Median BMI at treatment start was 23 (range [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34].…”

The Neutrophil-to-Lymphocyte Ratio Predicts Malignant Potential in Intraductal Papillary Mucinous Neoplasms

“…NLR is associated with tumor progression in pancreatic cancer. 34,35 Inflammatory cells accumulating between cancer cells play an important role in patient prognosis, because patients with lymphocyte infiltration around the tumor may have a better prognosis than those without infiltration patients. 36,37 Circulating IL-17-producing T cells release CXC chemokines recruiting neutrophils as well as promote the differentiation of tissue macrophages around the tumor into tumor-associated macrophages accelerating tumor progression.…”

Peripheral blood neutrophil count as a prognostic factor for patients with hepatocellular carcinoma treated with sorafenib

“…Recent studies have suggested that a systemic inflammatory state is associated with the malignant biological behavior of the tumor (14,15). In particular, the neutrophil-lymphocyte ratio (NLR) has been evaluated as a predictor of prognosis in various types of solid tumor, including gastric, colorectal, pancreatic, breast and lung cancers (16)(17)(18)(19)). An elevated NLR has already been shown to be associated with poor prognosis in patients with HCC treated by liver transplantation, surgical resection, or TACE (20)(21)(22).…”