Abstract
ABSTRACT Aim: To investigate the prognostic and predictive value of the inflammatory index Neutrophil/Lymphocyte ratio (NLR) in two homogeneous groups of chemotherapy-naive metastatic pancreatic adenocarcinoma (PA) pts treated with either gemcitabine (GEM) or GEM + oxaliplatin (GEMOXA). Methods: Consecutive PA pts (n = 103, male:female = 53:50) treated at a single center with either GEM (n = 45) or GEMOXA (n = 58), mainly according to patient preference or pre-existent diabetic neuropathy, were included between April'08- October'12. Exclusion criteria were treatment with steroids or active infection. NLR was assessed before and during therapy and correlated with outcome together with common clinical and biochemical variables. Results: Among 17 analyzed variables NLR, Karhofsky Perfomance Status (KPS), d-dimer and erythrocyte sedimentation rate were found to be significantly associated with median Overall Survival (mOS) at the univariate analysis. Only NLR and KPS were independent prognosticator at multivariate analysis, with NLR displaying the highest statistical significance (Exp(b) = 1.09, p 0.01, meaning 9% increase in the risk of death for 1-unit increase in NLR). GEMOXA was associated with longer mOS, but this was not statistically significant (8 v 5.8 months (mo), p 0.07). NLR was also predictive of oxaliplatin activity, as only pts with NLR > 2.5 (cutoff determined upon ROC analysis) derived benefit from GEMOXA over GEM (mOS 9.7 v 3.9 mo, respectively, in pts with NLR > 2.5, p 0.005 and 11.7 vs 11.8 mo, respectively, in pts with NLR 2.5 who reported a NLR 2.5 (7.7 v 5.0 mo, p 0.003). Conclusions: We were able to confirm the independent prognostic value of NLR for metastatic PA pts treated with gemcitabine-based first-line chemotherapy. NLR had also a predictive value in that only pts with high NLR (worse outcome) seem to benefit from the addition of oxaliplatin. NLR and KPS may help select pts for whom a particularly poor prognosis might justify more intensive, yet less tolerable, combination regimens. Disclosure: All authors have declared no conflicts of interest.
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