Preoperative Neutrophil-Lymphocyte and Lymphocyte-Monocyte Ratios Reflect Immune Cell Population Rearrangement in Resectable Pancreatic Cancer

Abstract

BackgroundNeutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) may serve as a simple index of the immune function. The aim of this study was to investigate the prognostic significance of NLR, PLR, and LMR in patients with resectable pancreatic ductal adenocarcinoma (PDAC) and to verify whether such biomarkers are associated with changes in populations of lymphoid cells.MethodsThe prognostic implications of blood count parameters were evaluated in a retrospective cohort of 442 subjects undergoing pancreatic resections for PDAC. Subpopulations of lymphocytes and monocytes in peripheral blood were identified by FACS in a prospective cohort of 54 patients.ResultsIn the univariate analysis, NLR < 5 and LMR ≥ 3 were associated with significantly longer median survival of 25.7 vs 12.6 months and 29.2 vs 13.1 months, respectively. PLR did not influence survival. The Cox proportional hazards model showed that high NLR (HR 1.66, 95 % CI 1.12 to 2.46, P = 0.012) and low LMR (HR 1.65, 95 % CI 1.06 to 2.58, P = 0.026) were independent predictors of poor prognosis. NLR ≥ 5 and LMR < 3 correlated with an approximately twofold decrease in counts of helper and cytotoxic T cells, B cells, and NK cells. High NLR was also accompanied with increased neutrophil counts, while low LMR showed increased numbers of monocytes, mostly classical.ConclusionsNLR and LMR may carry important prognostic information for patients with resected PDAC. The unfavorable prognosis likely correlates with reduced numbers of immune cells effective against the tumor and increased populations of cells involved in immune suppression.

After neoadjuvant chemotherapy platelet/lymphocyte ratios negatively correlate with prognosis in gastric cancer patients

“…In the last decade, more and more studies have reported that the systemic inflammatory response is closely related to a poor outcome in many types of tumor . The accumulating increase in NLR and PLR may be caused by peritumoral inflammation produced by a huge amount of cancer cells in patients with advanced cancer.…”

“…In the last decade, more and more studies have reported that the systemic inflammatory response is closely related to a poor outcome in many types of tumor. [17][18][19][20][21][22] The accumulating increase in NLR and PLR may be caused by peritumoral inflammation produced by a huge amount of cancer cells in patients with advanced cancer. Many studies demonstrate that PLR and NLR are useful biomarkers to predict prognostic outcome in unresectable gastric cancer, resectable gastric cancer, or gastric cancer patients who received chemotherapy.…”

Long-term outcomes and significance of preoperative lymphocyte-to-monocyte ratio as a prognostic indicator in patients with invasive pancreatic neoplasms after repeat pancreatectomy

“…A recent study described that high NLR and low LMR were associated with unfavorable prognoses of patients with pancreatic cancer. Additionally, both parameters were associated with marked alterations in the subsets of lymphocyte, monocyte, and neutrophil populations, possibly contributing to impaired defense against malignant tumors [10].…”

Prognostic value of a novel scoring system using inflammatory response biomarkers in non‐small cell lung cancer: A retrospective study

“…In recent years, the systemic inflammatory response (SIR) has been proven to play a key role in cancer progression, development, and metastasis . The neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and lymphocyte‐to‐monocyte ratio (LMR) are good markers of the SIR and have shown a significant correlation with clinical outcomes in multiple tumors . In particular, they are simple to derive and economical.…”

“…12 The neutrophil-tolymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) are good markers of the SIR and have shown a significant correlation with clinical outcomes in multiple tumors. [13][14][15] In particular, they are simple to derive and economical. However, almost all studies on these factors only focused on a single indicator and their results were inconsistent.…”