Clinical science
Preoperative hematologic markers as independent predictors of prognosis in resected pancreatic ductal adenocarcinoma: neutrophil-lymphocyte versus platelet-lymphocyte ratio

https://doi.org/10.1016/j.amjsurg.2009.08.041Get rights and content

Abstract

Background

The objective of this study was to investigate whether the preoperative hematologic markers, the platelet-lymphocyte ratio (PLR), or the neutrophil-lymphocyte ratio (NLR) ratio are significant prognostic indicators in resected pancreatic ductal adenocarcinoma.

Methods

A total of 84 patients undergoing pancreatoduodenectomy for pancreatic ductal adenocarcinoma over a 10-year period were identified from a retrospectively maintained database.

Results

The preoperative NLR was found to be a significant prognostic marker (P = .023), whereas PLR had no significant relationship with survival (P = .642) using univariate Cox survival analysis. The median overall survival in patients with an NLR of ≤3.0 (n = 55) was 13.7, 17.0 months in those with an NLR of 3.0 to 4.0 (n = 17) and 5.9 months in patients with a value of >4.0 (n = 12) (log rank, P = .016). The NLR retained its significance on multivariate analysis (P = .039) along with resection margin status (P = .001).

Conclusion

The preoperative NLR represents a significant independent prognostic indicator in patients with resected pancreatic ductal adenocarcinoma, whereas PLR does not.

Section snippets

Methods

Retrospective data were collected for patients undergoing classic Kausch-Whipple resection from June 1998 to June 2008. Only patients with histologic confirmation of pancreatic ductal adenocarcinoma were included in the study. Patient demographics, preoperative full blood count (FBC), operative details, intervention for biliary decompression, and standard histologic tumor characteristics were recorded. Pancreatic cancer specimens were processed and reported according to the Royal College of

Statistical analysis

Continuous data were analyzed using median, interquartile range, and 95% confidence intervals (CIs). Chi-square or Fisher exact tests were used for comparative analysis of categoric data. Survival data were analyzed using log-rank testing for univariate analysis and Cox proportional hazards for multivariate analysis. Corrected log rank P values were quoted for univariate survival where continuous prognostic data were dichotomized. All patients who died within 30 days of surgery were excluded

Results

In our institution, 84 patients underwent pancreatoduodenectomy for pancreatic ductal adenocarcinoma during the study period. The FBC was available in all the patients identified, and samples taken closest to the date of surgery were used for analysis. The median time of the FBC was 3 days before surgery (interquartile range 1–6.25 days). Demographic and hematologic data are shown in Table 1.

The mean overall survival in the group of 84 patients analyzed was 22 months (95% CI, 17–28 months). The

Comments

The association between cancer and inflammation was discovered over a century ago. However, a better understanding in tumor biology and recent links between tumor inflammation and prognosis has renewed interests in searching for an underlying mechanism.20, 21 Chronic inflammation represents both an important etiologic factor and responsive process to pancreatic cancer.22 A number of studies have suggested the association of both the NLR and the PLR with prognosis of cancer patients17, 18, 19, 23

Conclusions

This present study compares previously used preoperative hematologic prognostic markers in resected pancreatic cancer. In this cohort of patients, the PLR did not show a significant association with survival. For the first time, the NLR has been shown to be a significant independent prognostic indicator in resected pancreatic adenocarcinoma. Such a finding warrants further comparison of the NLR with other known prognostic markers such as C-reactive protein and Ca19-9 and its possible use in

Acknowledgments

The authors appreciate statistical guidance from Dr Graham Warren, Ph.D., Department of Medical Statistics, University of Nottingham.

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