Preoperative neutrophil-to-lymphocyte ratio and tumor-related factors to predict lymph node metastasis in patients with pancreatic ductal adenocarcinoma (PDAC)

Abstract

As a poor prognosis indicator in patients with pancreatic ductal adenocarcinoma (PDCA), lymph node (LN) metastasis is of great importance in treatment. Present study was performed to evaluate the predictive value of preoperative neutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR) and possible clinical parameters on the LN metastasis in PDCA patients. A total of 159 operable patients with PDCA were enrolled in our study. The clinical utility of NLR and other clinical parameters was evaluated by receiver operating characteristic (ROC) curves. Overall survival analysis indicated that LN metastasis is an independent prognostic factor. The logistic analysis was used to determine the independent parameters associated with LN metastasis. Ideal cutoff values for predicting LN metastasis are 2.12 for NLR and 130.96 for PLR according to the ROC curve. Multivariate analyses indicate that NLR (HR 2.588; 95% CI 1.246-5.376; P = 0.011), CA125 (HR 6.348; 95% CI 2.056-19.594; P = 0.001) and CA19-9 (HR 2.738; 95% CI 1.151-6.515; P = 0.023) are associated significantly with LN metastasis independently. Preoperative NLR, CA125 and CA19-9 are useful biomarkers for the prediction of LN metastasis in PDCA patients.

A meta-analysis of the utility of the neutrophil-to-lymphocyte ratio in predicting survival after pancreatic cancer resection

“…Screening and application of eligibility criteria produced 8 studies and a total of 1519 patients for analysis. [12][13][14][15][16][17][18][19] The characteristics of the included studies are shown in Table 1. Only one study did not find a statistically significant association between a high NLR and OS.…”

“…Only one study did not find a statistically significant association between a high NLR and OS. 19 The study by Bhatti et al used continuous data for the multivariate analysis and therefore the univariate HR result was used. 15 This was analysed as a subgroup with a study by Tao et al who only used a univariate model to analyse the NLR.…”

“…24,25 Half of the included studies failed to comment on the presence of biliary obstruction or instrumentation, whilst the rest simply commented that it was used selectively. 14,[17][18][19] Only half of the studies attempted to control for infection by excluding septic patients and therefore does limit the validity of their results. [14][15][16][17] Across the studies pooled in the meta-analysis, there was a significant amount of heterogeneity.…”

Contrast-enhanced CT radiomics for predicting lymph node metastasis in pancreatic ductal adenocarcinoma: a pilot study

“…However, postoperative pathological specimens are generally needed for detecting LN metastasis. In recent years, novel serum markers such as MMP7, MUC1, MUC2, and NLR have been proposed for detecting LN metastases preoperatively in PDAC patients [11][12][13]. However, their clinical application is limited because of technical and accuracy issues.…”

Preoperative neutrophil-to-lymphocyte ratio and tumor-related factors to predict microvascular invasion in patients with hepatocellular carcinoma

“…Chronic inflammation was correlated with the occurrence and development of HCC [ 21 , 22 ]. Neutrophils maintain the tumor microenvironment, exert protumoral functions, and enhance tumor cell invasion and metastasis, angiogenesis, and extracellular matrix remodeling in cancers [ 13 ], such as colorectal cancer, pancreatic carcinoma, and lung cancer, an thus are important in tumorigenesis and progression [ 23 , 24 ]. Studies have shown that neutrophils are crucial in tumor development and metastatic progression [ 14 , 25 ].…”