Neutrophil to Lymphocyte Ratio as a Predictor of Poor Prognosis in Metastatic Pancreatic Cancer Patients Treated with Nab-Paclitaxel plus Gemcitabine: A Propensity Score Analysis

Abstract

Background High neutrophil to lymphocyte ratio (NLR) has shown to be a predictor of poor outcomes in various malignancies, including pancreatic cancer. Methods We assessed 70 consecutive pts with histologically confirmed mPC who received chemotherapy with nab-paclitaxel/gemcitabine at two different European oncologic centers between January 2012 and November 2015. Variables assessed for prognostic correlations included age ≥ 66, sex, Karnofsky PS score, primary tumor site, baseline CA19.9 level ≥ 59xULN, 12-week decrease of the CA19.9 level ≥ 50% from baseline, basal bilirubin level, baseline NLR, biliary stent implantation, and liver metastasis. Survival analyses were generated according to the Kaplan-Meier method. Univariate and multivariate analyses were performed by a Cox proportional hazard model. Results According to NLR values, the patients were divided into two groups: high and low. Low group patients showed a better median PFS (7 months versus 5 months) and median OS (13 months versus 7 months) in respect to high group patients. At multivariate analysis, Karnofsky PS < 80% (HR = 0.4; CI 0.2–1.2), liver metastases (HR = 0.4; CI 0.18–0.82), and NLR ≥ 5 (HR = 2.7; 95% CI 1.4–5.2) were predictors of poorer OS. Based on the presence of one or more independent prognostic factors, three risk categories were identified: good-risk, intermediate-risk and poor-risk. The median OS was 22, 10, and 7 months, respectively. Conclusions Baseline NLR is an independent predictor of survival of patients with mPC receiving palliative chemotherapy and could be useful to develop a simple clinical score to identify a subgroup of patients with a low chance to benefit from chemotherapy.

Validation and application of a prognostic model for patients with advanced pancreatic cancer receiving palliative chemotherapy

“…In line with the GS model, the current study helped identify performance status, tumor stage, albumin, and NLR as independent prognostic factors that predict survival outcome. Several prognostic models have been developed for survival prediction among APC patients receiving first‐line palliative chemotherapy . Apart from patient factors (age, sex, performance status, weight loss), laboratory variables (albumin, white cell count, NLR, tumor markers) and tumor characteristics (stage, tumor size, metastatic organ, ascites) have all been reported to be independent prognosticators in different prognostic models .…”

“…Table summarizes and compares 13 published prognostic models for the prediction of the survival outcome of PC patients receiving palliative chemotherapy from a literature review . Only one of the models was designed prospectively ; the others were retrospective studies.…”

“…[14][15][16][17][18][19][20][21][22][23][24][25] Apart from patient factors (age, sex, performance status, weight loss), laboratory variables (albumin, white cell count, NLR, tumor markers) and tumor characteristics (stage, tumor size, metastatic organ, ascites) have all been reported to be independent prognosticators in different prognostic models. [14][15][16][17][18][19][20][21][22][23][24][25] Although no consistent prognosticators were reported among different reports, all models showed that in addition to tumor factors, patient features also were relevant to prognosis in PC patients. Consequently, the GS model was constructed by the combination of tumor-and patient-related factors, which may be more effective at predicting survival outcome than either tumor or patient factors alone.…”

“…[14][15][16][17][18][19][20][21][22][23][24][25] Only one of the models was designed prospectively 25 ; the others were retrospective studies. Of the 13 prognostic models, some were used for the prediction of survival outcome specifically for gemcitabine-based treatment, 11,14,16,19,22,24,25 while the other models consisted a broad spectrum of chemotherapeutic regimens. 15,17,18,20,21,23 The performance reflected by C-index ranged from 0.66 to 0.80 among these prognostic models.…”

Prognostic significance of the neutrophil-to-lymphocyte ratio with distal cholangiocarcinoma patients

“…An increasing number of studies have demonstrated that the inflammatory response plays a key role in the changes to the microenvironment of normal tissue, and thus is an important factor for tumor occurrence and development. [ 5 , 6 ] Several biomarkers have been identified as prognostic risk factors for various types of cancer, including interleukin-6 (IL-6) in ovarian cancer, [ 7 ] C-reactive protein (CRP) in hepatocellular carcinoma, [ 8 ] CRP and albumin (ALB) ratio in cervical cancer, [ 9 ] aspartate aminotransferase (AST) and the neutrophil ratio in intrahepatic cholangiocarcinoma, [ 10 ] and the platelet-to-lymphocyte ratio (PLR) in breast cancer. [ 11 ] The present study aimed to investigate the potential correlation between the NLR and the prognosis of DCC patients after radical surgery.…”