The Neutrophil-to-Lymphocyte Ratio is a Prognostic Biomarker in An Ethnically Diverse Patient Population with Advanced Pancreatic Cancer

  • Michael Shusterman
  • Erin Jou
  • Andreas Kaubisch
  • Jennifer W. Chuy
  • Lakshmi Rajdev
  • Santiago Aparo
  • Justin Tang
  • Nitin Ohri
  • Abdissa Negassa
  • Sanjay GoelEmail author
Original Research



The neutrophil-to-lymphocyte ratio (NLR) is associated with decreased overall survival in patients with pancreatic adenocarcinoma (PAC) in studies including few minority patients. We investigated the association between NLR and survival in patients with advanced PAC in an ethnically diverse population.


We retrospectively evaluated 226 patients with advanced PAC treated at Montefiore Medical Center between 2006 and 2015. Adjusted Cox proportion hazard regression models were utilized to derive effect estimates for survival duration.


Patients with a NLR ≤ 5 (126 patients, median age 66 years) were more likely to be non-Hispanic Black (30.8% vs. 20%), while patients with a NLR > 5 (70 patients, median age 66 years) were more likely to be non-Hispanic White (21.4% vs. 12.2%) or Hispanic (44.3% vs. 34%). A NLR > 5 compared with a NLR ≤ 5 was significantly associated with a worse overall survival when adjusted for a priori and exploratory variables from the univariate analysis (median survival 7.4 vs. 12 months, HR 1.650, 95% CI 1.139, 2.390).


In an ethnically diverse population, elevated NLR is an independent marker of poor prognosis and a potentially valuable factor in driving therapeutic decisions and defining prognosis for patients in the locally advanced or metastatic for PAC setting, meriting investigation in prospective clinical trials.


Pancreatic cancer Inflammation Healthcare disparities Prognostic factors Chemotherapy 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Michael Shusterman
    • 1
  • Erin Jou
    • 1
  • Andreas Kaubisch
    • 1
    • 4
  • Jennifer W. Chuy
    • 1
    • 4
  • Lakshmi Rajdev
    • 1
    • 4
  • Santiago Aparo
    • 1
    • 4
  • Justin Tang
    • 2
  • Nitin Ohri
    • 2
    • 4
  • Abdissa Negassa
    • 3
    • 4
  • Sanjay Goel
    • 1
    • 4
    Email author
  1. 1.Department of Medical OncologyMontefiore Medical CenterBronxUSA
  2. 2.Department of Radiation OncologyMontefiore Medical CenterBronxUSA
  3. 3.Department of Epidemiology and Population HealthBronxUSA
  4. 4.Albert Einstein College of MedicineBronxUSA

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