The Neutrophil/Lymphocyte Ratio at Diagnosis Is Significantly Associated with Survival in Metastatic Pancreatic Cancer Patients

Piciucchi, Matteo; Stigliano, Serena; Archibugi, Lívia; Zerboni, Giulia; Signoretti, Marianna; Barucca, Viola; Valente, Roberto; Fave, Gianfranco Delle; Capurso, Gabriele

doi:10.3390/ijms18040730

Cited by 60 publications

(41 citation statements)

References 25 publications

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“…In our study, initial NLR was significantly lower in LS patients with mPDAC. Those results are consistent with previous studies as the prognosis role of the NLR has been demonstrated in PDAC in both early and advanced stages . NLR should be considered a stratification factor in further clinical trials in order to determine whether patients with high NLR at diagnosis could benefit from intensified treatment or, on the contrary, should only require palliative treatment.…”

Section: Discussionsupporting

confidence: 92%

“…NLR is a biomarker of systemic inflammatory response and has been identified as an important prognostic factor for a number of malignancies, including colorectal cancer, renal cell carcinoma, and non‐small cell lung cancer . Elevated NLR at diagnosis has been strongly associated with worse progression‐free survival and OS . The inflammatory response plays an important role in cancer development and progression .…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Survivors in Metastatic Pancreatic Ductal Adenocarcinoma: A Retrospective and Matched Pair Analysis

et al. 2019

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Background. Metastatic pancreatic ductal adenocarcinoma (mPDAC) is an aggressive malignancy with a median overall survival (OS) of between 8 and 11 months. However, a significant number of patients experience a longer survival, more than 18 months. The aim of this study was to describe the "long-term survivor" population and to evaluate clinical and pathological factors that might affect survival. Materials and Methods. All patients with mPDAC diagnosed in the Centre Leon Bérard (Lyon, France) between January 2010 and June 2015 and who survived more than 18 months were identified. They were compared with a control cohort matched on age, sex, performance status, stage at diagnosis, primary tumor localization, treatment, and liver metastasis. Their clinical features, treatment modalities, and outcomes were analyzed. Results. A total of 94 patients were included, 47 in each cohort. Both cohorts had identical characteristics as follows: women (51%), performance status ≤1 (95.7%), median age at diagnosis (60 years), and metastasis at diagnosis (83%). Median OS was 26.87 months (95% confidence interval [CI] 23-31.08) in the long-term survivor group (LS group) and 9.79 months (95% CI 5.75-11.86) in the control group (C group). Potential factors of long-term survival were explored with a logistic model (LS group vs. C group). Three factors were identified as significant prognostic factors in the univariate analysis: lymphopenia (odds ratio [OR] ref: yes = 0.26), neutrophil-to-lymphocyte ratio (NLR; OR ref >5 = 0.31), and peritoneal carcinomatosis (OR ref: yes = 0.40). NLR was the only remaining factor in our backward selection procedure. Conclusion. A significant subset of patients with mPDAC can achieve long-term survival (≥18 months) in 2018. We identified low NLR as a significant prognostic factor associated with longterm survival in mPDAC. The Oncologist 2019;24:1543-1548 Implications for Practice: Metastatic pancreatic ductal adenocarcinoma (mPDAC) is one of the most lethal types of cancer. A subset of patients with mPDAC can achieve long-term survival (≥18 months) with a modern chemotherapy regimen, such as FOLFIRINOX or gemcitabine/nab-paclitaxel. We identified low neutrophil-to-lymphocyte ratio (NLR) as a significant prognostic factor associated with long-term survival in mPDAC. Prognostic factors such as NLR might allow accurate selection of patients with mPDAC in order to consider individual therapeutic approaches. NLR should be used as a stratification factor in clinical trials.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Long-Term Survivors in Metastatic Pancreatic Ductal Adenocarcinoma: A Retrospective and Matched Pair Analysis

et al. 2019

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“…Therefore, it is necessary to identify a valid, cost-effective, and reliable prognostic predictor that is available before treatment. In recent years, pretreatment subsets of peripheral blood cells, including lymphocytes, neutrophils, monocytes, and platelets, have been found to be associated with the prognosis of various cancers [ 13 , 14 , 15 , 16 , 17 ]. Pretreatment neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) can be regarded as 3 representative systemic inflammatory markers.…”

Section: Introductionmentioning

confidence: 99%

Clinical Usefulness of the Platelet-to Lymphocyte Ratio in Patients with Angiosarcoma of the Face and Scalp

Suzuki

Yamazaki

Aibe

et al. 2017

IJMS

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Angiosarcoma of the face and scalp (ASFS) is an extremely aggressive tumor that frequently metastasizes, often leading to death. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) are inflammatory markers that predict outcome of various cancers. We aimed to examine the relationship between pretreatment inflammatory markers and ASFS outcome. We included 17 patients with ASFS and a control group of 56 age- and gender-matched healthy individuals. Total white blood counts, neutrophil, lymphocyte, monocyte, and platelet counts were recorded; NLR, PLR, and LMR were calculated. Kaplan–Meier curves were used to calculate overall survival (OS) and distant metastasis-free survival (DMFS). Optimal cut-off values for each inflammatory marker were calculated using receiver operating curve analysis. Median follow-up was 22 months (range, 6–75). There was a statistically significant difference in absolute neutrophil counts and NLR between patient and control groups. Two-year OS and DMFS rates were 41% and 35%, respectively. In patients with tumors < 10 cm, PLR was highly correlated with DMFS, with the 2-year DMFS for those with a high PLR being 50% compared with 100% for those with a low PLR (p = 0.06). This study suggests that PLR is superior to NLR and LMR, and is a clinically useful marker in patients with ASFS with small tumors.

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“…In mPC, NLR (cutoff: ≥3.75) was confirmed to be associated with decreased OS and may serve as a useful combination marker to enhance the prognostic value of CA 19-9 (cutoff: ≥626 U/ml) alone, with an Area un-der the Curve (AUC) of 0.843 when these two values were combined [65]. The prognostic value of NLR has also been confirmed in a recent Italian study, with an NLR cutoff of >5 [66]. Regarding the prognostic value of preoperative C-reactive protein (CRP), evidence for some time has been less clear since studies on resectable PC reported conflicting results, as summarized in a previous systematic review [67].…”

Section: Clinical Factors and Blood Markers In Mpc Patientsmentioning

confidence: 68%

Surgical and local therapeutic concepts of oligometastatic pancreatic cancer in the era of effective chemotherapy

et al. 2019

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Background Pancreatic cancer (PC) remains a disease characterized by an extremely poor prognosis, which is often limited by advanced tumor stage at diagnosis. As surgery remains the only option for long-term survival, indications for resection to achieve a complete tumor removal have been extended in recent years, including locally advanced as well as metastatic disease. Methods Here, we provide a literature overview of modern multimodal treatment concepts of metastatic PC focused on surgery and local interventions including neoadjuvant concepts, stratification of patients, prognostic parameters, and oncological outcomes. Results The current literature lacks level I evidence studies on surgery in stage IV PC. The available observational studies show that resection for liver metastasis has been increasingly performed in recent years, outcomes improve after neoadjuvant therapy, and certain prognostic parameters can identify patients who benefit from this approach. In addition, interventional or radio-oncological liver-directed therapies have been evaluated showing the possibility of some disease control. Resection of pulmonary metastases is rarely performed, although this patient subgroup may have a more favorable prognosis than patients with Willem Niesen and Florian Primavesi contributed equally to the manuscript.

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The Neutrophil/Lymphocyte Ratio at Diagnosis Is Significantly Associated with Survival in Metastatic Pancreatic Cancer Patients

Cited by 60 publications

References 25 publications

Long-Term Survivors in Metastatic Pancreatic Ductal Adenocarcinoma: A Retrospective and Matched Pair Analysis

Long-Term Survivors in Metastatic Pancreatic Ductal Adenocarcinoma: A Retrospective and Matched Pair Analysis

Clinical Usefulness of the Platelet-to Lymphocyte Ratio in Patients with Angiosarcoma of the Face and Scalp

Surgical and local therapeutic concepts of oligometastatic pancreatic cancer in the era of effective chemotherapy

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