Neutrophil/lymphocyte ratio is a more sensitive systemic inflammatory response biomarker than platelet/lymphocyte ratio in the prognosis evaluation of unresectable pancreatic cancer

Abstract

Multiple cancers arise from sites of infection, chronic irritation, and inflammation. It has been widely accepted that pancreatic cancer is an inflammation-driven cancer. In this study, we investigated the application value of systemic inflammatory markers, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), in the prediction of chemotherapy response and prognosis in patients with late pancreatic cancer. 122 patients with inoperable pancreatic cancers were included and separated into two groups according to median values of NLR or PLR (NLR low:<3.81 or NLR high:≥3.81, and PLR low:<142.14 or PLR high≥142.14, respectively). Baseline NLR and PLR levels were significantly higher in pancreatic cancer patients compared with the healthy subjects. Neither of the baseline NLR or PLR levels could predict outcomes. Patients with low baseline level of NLR, but not PLR, had better responses to chemotherapy. Changes in NLR, but not PLR levels, were associated with the therapeutic efficacy. Patients who stayed in or dropped into the low NLR level subgroup after first-line chemotherapy had better responses, comparing to those stayed in or jumped into the high NLR level group. No similar results could be observed when the PLR level was investigated. Therefore, NLR is a more sensitive biomarker than PLR in the prediction of chemotherapy response of patients.

Prognostic Roles of Inflammatory Markers in Pancreatic Cancer: Comparison between the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio

“…However, in subgroup analyses, a high PLR was associated with worse OS only in Asian patients and in those who underwent mixed treatment (surgery plus chemo/radiotherapy). Our meta-analysis demonstrated that NLR is a better predictor of prognosis of patients with PC than PLR, which is also consistent with the results of previous studies [ 35 , 57 ]. Our analysis may provide important information to support treatment decision-making, including pursuing more aggressive treatments.…”

Pembrolizumab in Combination with the Oncolytic Virus Pelareorep and Chemotherapy in Patients with Advanced Pancreatic Adenocarcinoma: A Phase Ib Study

“…Treatment-associated changes in the T-cell repertoire Several studies have revealed that both local and systemic inflammation have an important role in cancer progression and response to immunotherapy. To assess the patient's ability to mount a systemic inflammatory response or immunological fitness for immunotherapy, we examined the neutrophil-to-lymphocyte ratio (NLR), which has been shown to correlate with patient outcomes in a variety of solid cancers, including PDAC (30)(31)(32). To perform this analysis, we separated patients into long-term survivors (LTS, OS > 6 months) and short-term survivors (STS, OS < 6 months).…”

Prognostic significance of blood inflammatory biomarkers NLR, PLR, and LMR in cancer—A protocol for systematic review and meta-analysis

“…As systemic alteration of inflammation leads to alteration in the peripheral blood leukocytes, NLR can act as a proxy measurement of the degree of inflammation in cancers. [4,5] Similarly, platelets release pro-inflammatory mediators, such as cytokines and chemokines, which exacerbate the inflammatory microenvironment in tumors, making PLR another viable measure of inflammation. [6,7] Monocytes have also been observed to have a key role in inflammation, also having been implicated in many inflammatory diseases, including atherosclerosis.…”