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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2015

01-02-2015 | Pancreatic Tumors

Blood Neutrophil–Lymphocyte Ratio Predicts Survival in Patients with Advanced Pancreatic Cancer Treated with Chemotherapy

Authors: Guopei Luo, MD, PhD, Meng Guo, PhD, Zuqiang Liu, MD, Zhiwen Xiao, MD, Kaizhou Jin, MD, PhD, Jiang Long, MD, PhD, Liang Liu, MD, PhD, Chen Liu, MD, PhD, Jin Xu, MD, PhD, Quanxing Ni, MD, Xianjun Yu, MD, PhD

Published in: Annals of Surgical Oncology | Issue 2/2015

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Abstract

Background

Although a high neutrophil-to-lymphocyte ratio (NLR) has been reported to be a predictor of poor survival in patients with pancreatic cancers, its prognostic role in patients with advanced pancreatic cancer undergoing chemotherapy remains unclear. This study was performed to determine the prognostic role of NLR in patients with advanced pancreatic cancer undergoing chemotherapy.

Methods

We retrospectively enrolled 403 patients undergoing chemotherapy for advanced pancreatic adenocarcinoma from 2002 to 2013. Univariate and multivariate analyses were performed to identify clinicopathological predictors of overall survival including baseline NLR (NLR before chemotherapy) and postchemotherapy NLR change (NLR change before and after one cycle of chemotherapy), using the Cox proportional hazards model. Clinicopathological characteristics related to baseline NLR and postchemotherapy NLR change were evaluated.

Results

Univariate and multivariate analyses showed that both baseline NLR (NLR ≥ 3.1 vs. NLR < 3.1, hazard ratio [HR] = 1.42; P = 0.001) and postchemotherapy NLR change (NLR ≥ 3.1 and increased vs. NLR < 3.1 and decreased, HR = 2.39; P = 0.000) were independent prognostic factors in overall survival. NLR ≥ 3.1 before chemotherapy and NLR postchemotherapy change were significantly correlated with distant metastasis, serum CA19-9 levels, and serum albumin levels.

Conclusions

Baseline NLR and postchemotherapy NLR change may serve as potential biomarkers for overall survival in patients with advanced pancreatic cancer undergoing chemotherapy.
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Literature
1.
2.
Liu L, Xu HX, Wang WQ, et al. Cavin-1 is essential for the tumor-promoting effect of caveolin-1 and enhances its prognostic potency in pancreatic cancer. Oncogene. 2014;33:2728–36.PubMedCrossRef
3.
Luo G, Long J, Zhang B, et al. Stroma and pancreatic ductal adenocarcinoma: an interaction loop. Biochim Biophys Acta. 2012;1826:170–8.PubMed
4.
5.
Long J, Luo GP, Xiao ZW, et al. Cancer statistics: current diagnosis and treatment of pancreatic cancer in Shanghai, China. Cancer Lett. 2014;346:273–7.CrossRef
6.
Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350:1200–10.PubMedCrossRef
7.
Ferrone CR, Pieretti-Vanmarcke R, Bloom JP, et al. Pancreatic ductal adenocarcinoma: long-term survival does not equal cure. Surgery. 2012;152:S43–9.PubMedCentralPubMedCrossRef
8.
Shi S, Yao W, Xu J, Long J, Liu C, Yu X. Combinational therapy: new hope for pancreatic cancer? Cancer Lett. 2012;317:127–35.PubMedCrossRef
9.
Azab B, Bhatt VR, Phookan J, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol. 2012;19:217–24.PubMedCrossRef
10.
Bhatti I, Peacock O, Lloyd G, Larvin M, Hall RI. Preoperative hematologic markers as independent predictors of prognosis in resected pancreatic ductal adenocarcinoma: neutrophil-lymphocyte versus platelet-lymphocyte ratio. Am J Surg. 2010;200:197–203.PubMedCrossRef
11.
Garcea G, Ladwa N, Neal CP, Metcalfe MS, Dennison AR, Berry DP. Preoperative neutrophil-to-lymphocyte ratio (NLR) is associated with reduced disease-free survival following curative resection of pancreatic adenocarcinoma. World J Surg. 2011;35:868–72.PubMedCrossRef
12.
Sharaiha RZ, Halazun KJ, Mirza F, et al. Elevated preoperative neutrophil:lymphocyte ratio as a predictor of postoperative disease recurrence in esophageal cancer. Ann Surg Oncol. 2011;18:3362–9.PubMedCentralPubMedCrossRef
13.
Shimada H, Takiguchi N, Kainuma O, et al. High preoperative neutrophil-lymphocyte ratio predicts poor survival in patients with gastric cancer. Gastric Cancer. 2010;13:170–6.PubMedCrossRef
14.
Stotz M, Gerger A, Eisner F, et al. Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer. Br J Cancer. 2013;109:416–21.PubMedCentralPubMedCrossRef
15.
Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 2005;91:181–4.PubMedCrossRef
16.
Sugiura T, Uesaka K, Kanemoto H, Mizuno T, Okamura Y. Elevated preoperative neutrophil-to-lymphocyte ratio as a predictor of survival after gastroenterostomy in patients with advanced pancreatic adenocarcinoma. Ann Surg Oncol. 2013;20:4330–7.PubMedCrossRef
17.
Chua W, Charles KA, Baracos VE, Clarke SJ. Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Br J Cancer. 2011;104:1288–95.PubMedCentralPubMedCrossRef
18.
Kao SC, Pavlakis N, Harvie R, et al. High blood neutrophil-to-lymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy. Clin Cancer Res. 2010;16:5805–13.PubMedCrossRef
19.
Yao Y, Yuan D, Liu H, Gu X, Song Y. Pretreatment neutrophil to lymphocyte ratio is associated with response to therapy and prognosis of advanced non-small cell lung cancer patients treated with first-line platinum-based chemotherapy. Cancer Immunol Immunother. 2013;62:471–9.PubMedCrossRef
20.
Lee S, Oh SY, Kim SH, et al. Prognostic significance of neutrophil lymphocyte ratio and platelet lymphocyte ratio in advanced gastric cancer patients treated with FOLFOX chemotherapy. BMC Cancer. 2013;13:350.PubMedCentralPubMedCrossRef
21.
Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.PubMedCrossRef
22.
Ino Y, Yamazaki-Itoh R, Shimada K, et al. Immune cell infiltration as an indicator of the immune microenvironment of pancreatic cancer. Br J Cancer. 2013;108:914–23.PubMedCentralPubMedCrossRef
23.
Fogar P, Sperti C, Basso D, et al. Decreased total lymphocyte counts in pancreatic cancer: an index of adverse outcome. Pancreas. 2006;32:22–8.PubMedCrossRef
24.
Ji H, Houghton AM, Mariani TJ, et al. K-ras activation generates an inflammatory response in lung tumors. Oncogene. 2006;25:2105–12.PubMedCrossRef
25.
Aliustaoglu M, Bilici A, Seker M, et al. The association of pre-treatment peripheral blood markers with survival in patients with pancreatic cancer. Hepatogastroenterology. 2010;57:640–5.PubMed
26.
Luo G, Xiao Z, Long J, et al. CA125 is superior to CA19-9 in predicting the resectability of pancreatic cancer. J Gastrointest Surg. 2013;17:2092–8.PubMedCrossRef
27.
Ferrone CR, Finkelstein DM, Thayer SP, Muzikansky A, Fernandez-delCastillo C, Warshaw AL. Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma. J Clin Oncol. 2006;24:2897–902.PubMedCrossRef
28.
Sarraf KM, Belcher E, Raevsky E, Nicholson AG, Goldstraw P, Lim E. Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J Thorac Cardiovasc Surg. 2009;137:425–8.PubMedCrossRef
29.
Farah R, Khamisy-Farah R. Association of neutrophil to lymphocyte ratio with presence and severity of gastritis due to Helicobacter pylori infection. J Clin Lab Anal. 2014;28:219–23.PubMedCrossRef
30.
Kaya H, Ertas F, Islamoglu Y, et al. Association between neutrophil to lymphocyte ratio and severity of coronary artery disease. Clin Appl Thromb Hemost. 2014;20:50–4.PubMedCrossRef
31.
Sefil F, Ulutas KT, Dokuyucu R, et al. Investigation of neutrophil lymphocyte ratio and blood glucose regulation in patients with type 2 diabetes mellitus. J Int Med Res. 2014;42:581–8.PubMedCrossRef
32.
Buyukkaya E, Karakas MF, Karakas E, et al. Correlation of neutrophil to lymphocyte ratio with the presence and severity of metabolic syndrome. Clin Appl Thromb Hemost. 2012;20:159–63.PubMedCrossRef
Metadata
Title
Blood Neutrophil–Lymphocyte Ratio Predicts Survival in Patients with Advanced Pancreatic Cancer Treated with Chemotherapy
Authors
Guopei Luo, MD, PhD
Meng Guo, PhD
Zuqiang Liu, MD
Zhiwen Xiao, MD
Kaizhou Jin, MD, PhD
Jiang Long, MD, PhD
Liang Liu, MD, PhD
Chen Liu, MD, PhD
Jin Xu, MD, PhD
Quanxing Ni, MD
Xianjun Yu, MD, PhD
Publication date
01-02-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 2/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-4021-y

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