Abstract
BackgroundWith growing evidence on the role of inflammation in cancer biology, the presence of a systemic inflammatory response has been postulated as having prognostic significance in a wide range of cancer types. The derived neutrophil to lymphocyte ratio (dNLR), which represents an easily determinable potential prognostic marker in daily practise and clinical trials, has never been externally validated in pancreatic cancer (PC) patients.MethodsData from 474 consecutive PC patients, treated between 2004 and 2012 at a single centre, were evaluated retrospectively. Cancer-specific survival (CSS) was assessed using the Kaplan-Meier method. To evaluate the prognostic relevance of dNLR, univariate and multivariate Cox regression models were applied.ResultsWe calculated by ROC analysis a cut-off value of 2.3 for the dNLR to be ideal to discriminate between patients’ survival in the whole cohort. Kaplan-Meier curve reveals a dNLR≥2.3 as a factor for decreased CSS in PC patients (p<0.001, log-rank test). An independent significant association between high dNLR≥2.3 and poor clinical outcome in multivariate analysis (HR = 1.24, CI95% = 1.01–1.51, p = 0.041) was identified.ConclusionIn the present study we confirmed elevated pre-treatment dNLR as an independent prognostic factor for clinical outcome in PC patients. Our data encourage independent replication in other series and settings of this easily available parameter as well as stratified analysis according to tumor resectability.
Highlights
Pancreatic cancer (PC) is the ninth most common cancer but ranks forth as a cause of cancer-related mortality worldwide [1,2]
The prognosis of patients who undergo resection of pancreatic cancer (PC) with curative intention is generally poor unless they have early-stage disease, due to the fact that more than 85% of tumors have already extended beyond the organ margins at the time of diagnosis and invade the perineural spaces within and beyond the pancreas [5,6]
Patients where PC diagnosis was made by cytology or assumed by radiological assessment without proven histology from biopsy or surgical resection samples were not included in this study
Summary
Pancreatic cancer (PC) is the ninth most common cancer but ranks forth as a cause of cancer-related mortality worldwide [1,2]. It is crucial to elucidate the biological mechanisms that contribute to tumor progression and identify prognostic factors that are helpful for patient’s counselling and individual risk assessment Traditional prognostic factors, such as tumor size, histologic grade, vascular invasion, lymph node metastases, distant metastases and perineural invasion have been routinely used to predict outcome for PC patients [7,8,9,10]. These parameters are generally useful, they are often insufficient in optimally predicting the individual patients’ prognosis. The derived neutrophil to lymphocyte ratio (dNLR), which represents an determinable potential prognostic marker in daily practise and clinical trials, has never been externally validated in pancreatic cancer (PC) patients
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