Changes in total lymphocyte count and neutrophil-to-lymphocyte ratio after curative pancreatectomy in patients with pancreas adenocarcinoma and their prognostic role

Abstract

To assess the prognostic significance of postoperative changes in immune status represented by total lymphocyte count (TLC) and neutrophil-to-lymphocyte ratio (NLR) in resectable pancreatic cancer. Patients who underwent curative pancreatectomy for pancreatic adenocarcinoma were divided into high and low groups according to cut-off values of TLC, and NLR measured preoperatively, immediately after surgery, and 1- or 6-month after surgery. Oncologic outcomes were compared between the two groups at different times, and prognostic roles of TLC and NLR were evaluated. Of 193 patients, the median follow-up time was 22 months, and median survival was 18 months. Their immunologic status deteriorated within 3-4 days after the operation and recovered after that. At 1- and 6-month postoperatively, overall survival rates were significantly lower in the group with high NLR (> 2.535 and > 3.21, respectively) and low TLC (< 1.66 × 109/L and < 1.62 × 109/L, respectively). In multiple regression analysis, elevated NLR at postoperative 1- and 6-month and decreased TLC at postoperative 1-month were significant prognosis predictors. Changes in immune status such as decreased TLC and elevated NLR at postoperative 1- and 6-month are effective prognostic predictors after curative pancreatectomy in patients with pancreatic adenocarcinoma.