The Prognostic Value of Preoperative Neutrophil-to-Lymphocyte Ratio in Resected Patients with Pancreatic Adenocarcinoma

• Published in: World journal of surgery 2018-11, Vol.42 (11), p.3736-3745
• Main Authors: Fang, Le-ping, Xu, Xiao-yan, Ji, Yu, Huang, Pu-wen
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adenocarcinoma; Adult; Aged; Carcinoma, Pancreatic Ductal - blood; Carcinoma, Pancreatic Ductal - mortality; Carcinoma, Pancreatic Ductal - pathology; Carcinoma, Pancreatic Ductal - surgery; Cardiac Surgery; Chemotherapy; Female; General Surgery; Humans; Lymphocytes; Male; Medical prognosis; Medicine; Medicine & Public Health; Metastases; Middle Aged; Multivariate analysis; Neoplasm Staging; Neutrophils; Original Scientific Report; Pancreas; Pancreatic cancer; Pancreatic Neoplasms - blood; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Patients; Preoperative Period; Prognosis; Qualitative analysis; Regression analysis; Retrospective Studies; Statistical tests; Subgroups; Surgery; Survival; Survival analysis; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-018-4686-7

Purpose This research aims to analyze neutrophil-to-lymphocyte ratio (NLR) for resectable pancreatic ductal adenocarcinoma (PDAC) patients and reveal its predictive value. Methods We enrolled 389 pancreatic adenocarcinoma patients who had undergone curative surgery between January 1, 2008 and August 15, 2015 in Jiangsu Provincial People’s Hospital, and they were followed up until December 20, 2016. Among them, 219 patients had definite recurrence record in our hospital. The appropriate cutoff value for the NLR was obtained from X-tile software. The association between qualitative variables and NLR was analyzed by Chi-square test or Fisher’s exact test, and for quantitative values, the association was analyzed by independent Student’s t test. Additionally, survival analysis was performed by Kaplan–Meier plots. Independent prognostic factors were found according to Cox regression analysis. Results Based on univariate analysis, the elevated preoperative NLR had an important influence on the decreased recurrence-free survival (RFS) (8.2 vs. 14.9 months) and overall survival (OS) (13.7 vs. 22 months), and this result also counted in the multivariate analysis. Regarding OS, both patients with or without postoperative chemotherapy can obtain benefits from low NLR according to subgroup analysis. Stage I and II pancreatic adenocarcinoma patients can get longer OS and RFS from low NLR, while patients with stage III cancer cannot. Regarding recurrence site, high NLR level was also related to distant metastasis ( P  = 0.02). Conclusion Preoperative NLR level could be a useful prognostic indication for resectable pancreatic adenocarcinoma patients.