Pretreatment Neutrophil to Lymphocyte Ratio (NLR) Is Prognostic in Resectable Pancreatic Cancer

Abstract

Purpose/Objective(s): To assess resectability and overall survival (OS) among locally advanced pancreatic cancer (LAPC) patients treated with induction chemotherapy (CT) followed by dose-escalated chemoradiation using intensity-modulated radiation therapy (IMRT). Materials/Methods: We reviewed records of 135 LAPC patients were treated with induction CT (median duration 3.2 months) followed by IMRT (median dose 56Gy) between 11/2006 and 11/2012. Patients were deemed to have locally advanced disease based on T4 disease or unreconstructable involvement of portal vein/hepatic artery on imaging (n Z 112) or were found to be unresectable after an attempted resection (n Z 23). Induction CTwas gemcitabine-based (nZ 99) or FOLFIRINOX (nZ 32); concurrent CT was biweekly gemcitabine (40mg/m) in 89 pts, continuous 5-fluorouracil (225mg/m) in 27 pts or Xeloda (825mg/m2 BID)in 10 pts. After chemoradiation, 80 patients received maintenance CT. Results: With 20.1 month’s median follow-up, median OS was 19.7 months. Twenty-six (19%) patients underwent resection 4.1 months (mean) after chemoradiation; 22 (16%) had negative margins, one of whom had a pathologic complete response and 4 had a microscopically positive margin. The median treatment response on pathology was 70% [5-100] and 23 patients had negative nodes. One-year and 2-year OS for all the patients were 86% and 47%, respectively and for those who underwent surgical resection, the 1and 2-year OS were 96% and 88%, respectively. Partial response to chemoradiation and duration of maintenance CT were associated with undergoing surgery (p Z 0.022 and p Z 0.03 respectively) on univariate analysis. On multivariate analysis, clinical nodal staging and duration of maintenance CTwere associated with undergoing surgery (pZ 0.027 and p Z 0.0091 respectively). On univariate analysis, duration of maintenance CT were associated with improved OS (p Z 0.0167). On multivariate analysis, response to IMRT and duration of maintenance CT were associated with better OS (pZ 0.0125 and pZ 0.0123 respectively). Conclusions: Induction CT followed by chemoradiation for LAPC is associated with R0 resections in 16% of patients and an improved OS. Identifying both clinical and genomic predictors of response to chemoradiation may help in selecting a subgroup of patients with LAPC who should receive radiation therapy with the goal of allowing for surgical resection. Author Disclosure: C. Hajj: None. F. Huguet: None. A. Wu: None. W. Shi: None. Z. Zhang: None. E. O’Reilly: None. C. Winston: None. D. Reidy: None. A. Ho: None. P. Allen: None. K.A. Goodman: None.