Unveiling the mechanisms of immune evasion in pancreatic cancer: may it be a systemic inflammation responsible for dismal survival?

  • K. HolubEmail author
  • C. Conill
Research Article



Pancreatic cancer (PC) is one of the most aggressive malignancies with no effective treatment if diagnosed in advanced stage. Systemic inflammation is a recognized characteristic of cancer progression, and we believe that the understanding of the influence of inflammatory parameters may contribute to therapeutic improvement in PC. Here, we validated the Eosinophil/Lymphocyte Ratio (ELR) together with the Neutrophil/Lymphocyte Ratio (NLR) and their components, as prognostic factors in PC patients treated with chemoradiation.


A total of 66 consecutive patients (p) diagnosed with PC stage I–III and treated with External Beam Radiotherapy + chemotherapy ± surgery (28p) in our institution from 2007 to 2018 were retrospectively evaluated. The impact of pre-treatment ELR ≥ 0.04, NLR ≥ 1.9, neutrophilia (≥ 7.0 × 10(9)/l), eosinophilia (≥ 0.5 × 10(9)/l) and lymphopenia (< 1.0 × 10(9)/l) on Overall Survival (OS) and Time-to-Progression (TTP) was evaluated both in the entire cohort and separately according to surgical status.


Higher ELR was associated with longer OS and TTP, both in surgically treated and not operable patients. On univariate analysis, elevated ELR was associated with better OS (HR = 0.3, 95% IC 0.13–0.65, p = 0.003), contrarily to neutrophilia (HR = 2.7, 95% IC 1.2–6.5, p = 0.026) and age > 50 years (HR = 2.6, 95% IC 1.03–6.6, p = 0.044), while NLR, lymphopenia and Ca-19.9 were not significant. On multivariate regression, independent prognosticators for OS were: ELR, age and neutrophilia; while for TTP: ELR, neutrophilia, eosinophilia and lymphopenia.


The host’s immune response influences survival outcomes of PC patients and may be of interest for future research.


Pancreatic cancer Systemic inflammation Neutrophil/lymphocyte ratio Eosinophil/lymphocytes ratio Eosinophils Neutrophils 


Author contributions

This article was principally written by KH, with review contributions from CC. Both authors have read and approved the final version of the manuscript.


There was no specific funding for this study.

Compliance with ethical standards

Data availability

The datasets used and/or analysed during the current study are available on reasonable request.

Conflict of interest

No potential conflict of interest to disclose.

Ethics approval

Our study was approved by the Ethical Committee of the Hospital Clinic de Barcelona.

Informed consent

All patients included in the study signed the informed consent for treatment, data processing and publication.

Supplementary material

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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  1. 1.Radiotherapy DepartmentGustave Roussy Cancer CampusVillejuif, ParisFrance
  2. 2.University of BarcelonaBarcelonaSpain
  3. 3.Radiation Oncology DepartmentHospital Clinic de BarcelonaBarcelonaSpain

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