Skip to main content

Advertisement

SpringerLink
Log in

The postoperative platelet-to-lymphocyte ratio predicts the outcome of patients undergoing pancreaticoduodenectomy for pancreatic head cancer

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

The preoperative platelet-to-lymphocyte ratio (PLR) has been reported as an important prognostic index for pancreatic ductal adenocarcinoma (PDAC); however, the significance of the postoperative (post-op) PLR for this disease has not been elucidated.

Methods

We analyzed data on 118 patients who underwent pancreaticoduodenectomy for pancreatic head PDAC, collected from a prospectively maintained database. The post-op PLR was obtained by dividing the platelet count after surgery by the lymphocyte count on post-op day (POD) 14. The patients were divided into two groups according to a post-op PLR of < 310 or ≥ 310. Survival data were analyzed.

Results

A high post-op PLR was identified as a significant prognostic index on univariate analysis for disease-free survival (DFS) and overall survival (OS). The post-op PLR remained significant, along with tumor differentiation and adjuvant chemotherapy, on multivariate analysis for OS (hazard ratio = 2.077, 95% confidence interval: 1.220–3.537; p = 0.007). The post-op PLR was a significant independent prognostic index for poor DFS, along with tumor differentiation and lymphatic invasion, on multivariate analysis (hazard ratio = 1.678, 95% confidence interval: 1.056–2.667; p = 0.028).

Conclusions

The post-op PLR in patients with pancreatic head PDAC was an independent predictor of DFS and OS after elective resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2000;71:209–49.

    Article  Google Scholar 

  2. Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013;310:1473–81.

    Article  PubMed  CAS  Google Scholar 

  3. Conroy T, Hammel P, Hebbar M, Abdelghani MB, Wei AC, Raoul JL, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med. 2018;379:2395–406.

    Article  PubMed  CAS  Google Scholar 

  4. Sakaguchi T, Satoi S, Yamamoto T, Yamaki S, Sekimoto M. The past, present, and future status of multimodality treatment for resectable/borderline resectable pancreatic ductal adenocarcinoma. Surg Today. 2020;50(4):335–43.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gall TMH, Jacob J, Frampton AE, Krell J, Kyriakides C, Castellano L, et al. Reduced dissemination of circulating tumor cells with no-touch isolation surgical technique in patients with pancreatic cancer. JAMA Surg. 2014;149:482–5.

    Article  PubMed  Google Scholar 

  6. Nierodzik ML, Plotkin A, Kajumo F, Karpatkin S. Thrombin stimulates tumor-platelet adhesion in vitro and metastasis in vivo. J Clin Invest. 1991;87:229–36.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Shirai Y, Shiba H, Sakamoto T, Horiuchi K, Haruki K, Fujiwara Y, et al. Preoperative platelet to lymphocyte ratio predicts outcome of patients with pancreatic ductal adenocarcinoma after pancreatic resection. Surgery. 2015;158:360–5.

    Article  PubMed  Google Scholar 

  8. Shirai Y, Shiba H, Haruki K, Horiuchi T, Saito N, Fujiwara Y, et al. Preoperative platelet-to-albumin ratio predicts prognosis of patients with pancreatic ductal adenocarcinoma after pancreatic resection. Anticancer Res. 2017;37:787–93.

    Article  PubMed  Google Scholar 

  9. Watanabe J, Otani S, Sakamoto T, Arai Y, Hanaki T, Amisaki M, et al. Prognostic indicators based on inflammatory and nutritional factors after pancreaticoduodenectomy for pancreatic cancer. Surg Today. 2016;46:1258–67.

    Article  PubMed  CAS  Google Scholar 

  10. Asari S, Matsumoto I, Toyama H, Shinzeki M, Goto T, Ishida J, et al. Preoperative independent prognostic factors in patients with borderline resectable pancreatic ductal adenocarcinoma following curative resection: the neutrophil-lymphocyte and platelet-lymphocyte ratios. Surg Today. 2016;46:583–92.

    Article  PubMed  Google Scholar 

  11. Bong TSH, Tan GHC, Chia C, Soo KC, Teo MCC. Preoperative platelet-lymphocyte ratio is an independent prognostic marker and superior to carcinoembryonic antigen in colorectal peritoneal carcinomatosis patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Int J Clin Oncol. 2017;22:511–8.

    Article  PubMed  CAS  Google Scholar 

  12. Kakita A, Takahashi T, Yoshida M, Furuta K. A simpler and more reliable technique of pancreatojejunal anastomosis. Surg Today. 1996;26:532–5.

    Article  PubMed  CAS  Google Scholar 

  13. Fujii T, Sugimoto H, Yamada S, Kanda M, Suenaga M, Takami H, et al. Modified Blumgart anastomosis for pancreaticojejunostomy: technical improvement in matched historical control study. J Gastrointest Surg. 2014;18:1108–15.

    Article  PubMed  Google Scholar 

  14. Brierley DJ GK, Wittekind C. TNM Classification of Malignant Tumor, 8th edition. Wiley-Blackwell. 2017.

  15. Bassi C, Marchegiani G, Dervenis C, Sarr M, Hilal MA, Adham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161:584–91.

    Article  PubMed  Google Scholar 

  16. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Alexandrakis MG, Passam FH, Moschandrea IA, Christophoridou AV, Pappa CA, Coulocheri SA, et al. Levels of serum cytokines and acute phase proteins in patients with essential and cancer-related thrombocytosis. Am J Clin Oncol. 2003;26:135–40.

    Article  PubMed  CAS  Google Scholar 

  18. Ivert T, Dalén M, Ander C, Stålesen R, Lordkipanidzé M, Hjemdahl P, et al. Increased platelet reactivity and platelet-leukocyte aggregation after elective coronary bypass surgery. Platelets. 2019;30:975–81.

    Article  PubMed  CAS  Google Scholar 

  19. Pugalenthi A, Protic M, Gonen M, Kingham TP, D’Angelica MI, Dematteo RP, et al. Postoperative complications and overall survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. J Surg Oncol. 2016;113:188–93.

    Article  PubMed  Google Scholar 

  20. Aoyama T, Murakawa M, Katayama Y, Yamaoku K, Kanazawa A, Higuchi A, et al. Impact of postoperative complications on survival and recurrence in pancreatic cancer. Anticancer Res. 2015;35:2401–9.

    PubMed  Google Scholar 

  21. Wojtukiewicz MZ, Sierko E, Hempel D, Tucker SC, Honn KV. Platelets and cancer angiogenesis nexus. Cancer Metastasis Rev. 2017;36:249–62.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Goubran HA, Stakiw J, Radosevic M, Burnouf T. Platelets effects on tumor growth. Semin Oncol. 2014;41:359–69.

    Article  PubMed  CAS  Google Scholar 

  23. Bastida E, Almirall L, Ordinas A. Tumor-cell-induced platelet aggregation is a glycoprotein-dependent and lipoxygenase-associated process. Int J Cancer. 1987;39:760–3.

    Article  PubMed  CAS  Google Scholar 

  24. Amo L, Tamayo-Orbegozo E, Maruri N, Eguizabal C, Zenarruzabeitia O, Riñón M, et al. Involvement of platelet-tumor cell interaction in immune evasion. Potential role of podocalyxin-like protein 1. Frontier Oncol. 2014;4:245.

    Google Scholar 

  25. Quail DF, Joyce JA. Microenvironmental regulation of tumor progression and metastasis. Nat Med. 2013;19:1423–37.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Miyashita T, Tajima H, Makino I, Nakagawa H, Kitagawa H, Fushida S, et al. Metastasis-promoting role of extravasated platelet activation in tumor. J Surg Res. 2015;193:289–94.

    Article  PubMed  CAS  Google Scholar 

  27. Okazaki M, Yamaguchi T, Tajima H, Fushida S, Ohta T. Platelet adherence to cancer cells promotes escape from innate immune surveillance in cancer metastasis. Int J Oncol. 2020;57:980–8.

    PubMed  CAS  Google Scholar 

  28. Ishikawa M, Nishioka M, Hanaki N, Miyauchi T, Kashiwagi Y, Ioki H, et al. Perioperative immune responses in cancer patients undergoing digestive surgeries. World J Surg Oncol. 2009;7:7.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Yang MW, Tao LY, Jiang YS, Yang JY, Huo YM, Liu DJ, et al. Perineural invasion reprograms the immune microenvironment through cholinergic signaling in pancreatic ductal adenocarcinoma. Cancer Res. 2020;80:1991–2003.

    Article  PubMed  CAS  Google Scholar 

  30. Uesaka K, Boku N, Fukutomi A, Okamura Y, Konishi M, Matsumoto I, et al. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet. 2016;388:248–57.

    Article  PubMed  CAS  Google Scholar 

  31. Rothwell PM, Wilson M, Price JF, Belch JF, Meade TW, Mehta Z. Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials. Lancet. 2012;379:1591–601.

    Article  PubMed  CAS  Google Scholar 

  32. Khalaf N, Yuan C, Hamada T, Cao Y, Babic A, Morales-Oyarvide V, et al. Regular use of aspirin or non-aspirin nonsteroidal anti-inflammatory drugs is not associated with risk of incident pancreatic cancer in two large cohort studies. Gastroenterology. 2018;154:1380-90.e5.

    Article  PubMed  CAS  Google Scholar 

  33. Coyle C, Cafferty FH, Rowley S, MacKenzie M, Berkman L, Gupta S, et al. ADD-ASPIRIN: A phase III, double-blind, placebo controlled, randomised trial assessing the effects of aspirin on disease recurrence and survival after primary therapy in common non-metastatic solid tumours. Contemp Clin Trial. 2016;51:56–64.

    Article  Google Scholar 

  34. Pretzsch E, D’Haese JG, Renz B, Ilmer M, Schiergens T, Miksch RC, et al. Effect of platelet inhibition with perioperative aspirin on survival in patients undergoing curative resection for pancreatic cancer: a propensity score matched analysis. BMC Surg. 2021;21:98.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

Download references

Funding

This work was supported by Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Number 20K17665 and 23K08202 (Dr. Yoshihiro Shirai).

Author information

Authors and Affiliations

  1. Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Yoshihiro Shirai, Ryoga Hamura, Yoshiaki Tanji, Tomohiko Taniai, Mitsuru Yanagaki, Koichiro Haruki, Kenei Furukawa, Shinji Onda, Taro Sakamoto, Takeshi Gocho & Toru Ikegami

  2. Department of Gastrointestinal Surgery, Saku General Hospital Advanced Care Center, Nagano, 385-0051, Japan

    Yoshihiro Shirai, Ryoga Hamura & Shinji Onda

Authors
  1. Yoshihiro Shirai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryoga Hamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshiaki Tanji
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tomohiko Taniai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mitsuru Yanagaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Koichiro Haruki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kenei Furukawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shinji Onda
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Taro Sakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takeshi Gocho
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Toru Ikegami
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YS and RH designed the study. YS wrote the main manuscript. YT, TT, MY, KH, KF, SO and TS acquired the data. TG and TI made a critical revision. All the authors reviewed and approved the manuscript.

Corresponding author

Correspondence to Yoshihiro Shirai.

Ethics declarations

Conflict of interest

We have no conflicts of interests to declare for this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shirai, Y., Hamura, R., Tanji, Y. et al. The postoperative platelet-to-lymphocyte ratio predicts the outcome of patients undergoing pancreaticoduodenectomy for pancreatic head cancer. Surg Today 54, 247–257 (2024). https://doi.org/10.1007/s00595-023-02727-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-023-02727-4

Keywords

Search

Navigation