Prognostic role of the neutrophil-to-lymphocyte ratio (NLR) in patients with operable ampullary carcinoma

Abstract

Ampullary carcinoma or cancer of the ampulla of Vater is a rare malignancy with a high recurrence rate. Although cost-effective biomarkers, such as neutrophil-to-lymphocyte ratio (NLR), have been investigated in other cancers for predicting postoperative prognosis in patients, studies on the role of NLR in ampullary cancer are scarce. Here we aimed to evaluate the prognostic significance of preoperative NLR in patients with operable ampullary carcinoma. We retrospectively reviewed 87 patients who underwent pancreaticoduodenectomy for the treatment of ampullary carcinoma between December 1999 and April 2014. The association between NLR and prognosis (overall survival [OS] and disease-free survival [DFS]) was evaluated. Possible correlations between NLR and clinicopathological features were also assessed. The 5-year DFS and OS rates after surgery in patients with ampullary carcinoma were 51% and 63%, respectively. A high NLR (≥3.0) was found in 40 patients. The NLR was a significant prognostic factor for both OS and DFS. Multivariate analysis revealed a significantly worse OS in patients with positive surgical margins and NLR ≥3 (p = 0.001). Patients with T3-T4 stage (p = 0.029) and NLR ≥3 (p = 0.043) had a lower DFS. Patients with a high NLR had a significantly worse Eastern Cooperative Oncology Group performance score. Preoperative NLR is an independent and significant predictive factor of prognosis in patients with ampullary carcinoma. An elevated pretreatment NLR (e.g., NLR ≥3) may be considered as a biomarker for poor prognosis in patients with ampullary carcinoma.

<p>Combination of the preoperative albumin to globulin ratio and neutrophil to lymphocyte ratio as a novel prognostic factor in patients with triple negative breast cancer</p>

“…Lymphocyte counts can reflect endogenous cancer resistance of the immune system 27,28. By the combination of neutrophils and lymphocytes, high NLR level has been shown to be a promising indicator of poor prognosis for patients with cancer 29–31. In this study, the optimal cutoff value of 2.93 for the NLR was found to exhibit superior prognostic value for the DFS of TNBC.…”

Prognostic Power of Inflammatory Response Scoring Systems in Periampullary Pancreatic Cancer: A Systematic Review

“…[12] Four studies evaluated NLR in patients with PPC. [10,[12][13][14] Garcea et al demonstrated that NLR has no pre-operative value in discriminating between operable and non-operable disease and has no value in detecting occult disease. [10] Kumamoto et al found that a higher NLR as associated with major complications.…”

“…[13] Demirci et al found that an NLR of more than 3 was associated with overall survival and disease-free survival. [14] Three studies aimed to assess the role of PLR in patients with PC. [10,[15][16][17] Garcea et al showed no role of PLR in assessing the benefit of staging laparoscopy in PPC patients.…”

Progress and Challenges in Precise Treatment of Tumors With PD-1/PD-L1 Blockade

“…Neutrophil-lymphocyte ratio (NLR) is a significant prognostic marker in many tumor therapies (49)(50)(51)(52)(53); high NLR indicates host inflammation and is associated with shorter OS in several tumor types (49). Comparisons of NLR before and after treatment with PD-1/PD-L1 inhibitors showed that patients with NLR ≥4 were found to have shorter OS and disease progression-free time before treatment (54).…”