Elevated NLR predicts poor prognosis after resection of pancreatic ductal adenocarcinoma and it is superior to PLR as an adverse prognostic factor

Abstract

Background: Recent evidence indicates that inflammation is an essential component of pathogenesis and progression of cancer. In this study, we analysed two indexes of systemic inflammation, the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), with overall survival (OS) in pancreatic ductal adenocarcinoma(PDAC) treated with resection following or not neoadjuvant chemotherapy/ chemoradiation. Methods: In this retrospective analaysis, 127 patients were enrolled. The NLR and PLR were calculated on the basis of pre-treatment blood cell count. An NLR>4 and a PLR >120 were considered to be elevated. Overall survival (OS) was analyzed in relation to NLR and PLR values by using both Kaplan-Meier and multivariate Cox-regression methods. Results: Both high NLR and high PLR were associated with decreased OS (HR 2.51; 95%CI, 1.42-4.45; P=0.001, and HR 1.63; 95%CI, 1.02-2.59 ;P=0.038 respectively) in univariate analysis. In multivariate analysis, high NLR, but not high PLR, was an independent predictor of decreased OS (HR 2.05;95%CI,1.11-3.78;P=0.043). When we divided patients into three groups (group 1: normal both NLR and PLR, group 2: high NLR or high PLR, group 3: high both NLR and PLR) the three-years OS rates for these groups were 48%,32%,7%(P=0.001) respectively. Conclusion: In this study, we indicate that pre-treatment NLR is an independent adverse prognostic factor in patients who undergo resection for pancreatic ductal adenocarcinoma following or not neoadjuvant chemotherapy/ chemoradiation.