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Does Preoperative Serum Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), and Lymphocyte to Monocyte Ratio (LMR) Predict Prognosis Following Radical Surgery for Pancreatic Adenocarcinomas? Results of a Retrospective Study

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Abstract

Background

Pretherapy serum neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) have been shown to predict prognosis in patients with pancreatic ductal adenocarcinoma (PDAC). However, the published literature is conflicting; hence, we aimed to evaluate their role in predicting survival outcomes in operated patients of PDAC.

Methods

A retrospective analysis was performed in all operated cases of PDAC who underwent curative resection between 2011 and 2018. The pretherapy NLR, PLR, and LMR were calculated and analyzed with respect to pathological and survival outcomes

Results

One hundred thirty-four operated patients were included. The median overall survival for NLR of less than 2, 2.7, and 5 was 30.8, 27.2, and 27.5 months and for NLR of more than 2, 2.7, and 5 was 22.9, 21.6, and 21.5 months, respectively, and was statistically insignificant (p-value—0.32, 0.91, 0.34, respectively). Similarly, the PLR was not significant for a cutoff of 150 (p-value—0.27), and LMR was not significant for a cutoff of 2.8 (p-value—0.13) and 4.8 (p-value—0.11). On univariate analysis age, CA 19–9 levels, perineural invasion, margin positivity, lymph node positivity, and TNM stage were found to have a significant correlation with overall survival. However, on multivariate analysis, only TNM stage was found to be significant.

Conclusion

The NLR, PLR, and LMR do not correlate with overall survival in operated patients with PDAC in this study. A combination of inflammatory markers or their dynamic testing might probably achieve prognostic significance.

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References

  1. Ferrone CR, Pieretti-Vanmarcke R, Bloom JP, et al. Pancreatic ductal adenocarcinoma: long-term survival does not equal cure. Surgery. 2012;152:S43–9.

    Article  Google Scholar 

  2. Kim WJ, Lim TW, Park PJ, Choi SB, Kim WB. Prognostic impact of the combination of the neutrophil-to-lymphocyte ratio and serum carbohydrate antigen 19–9 in patients with pancreas head cancer. ANZ J Surg. 2019;89(7–8):E302–7.

    PubMed  Google Scholar 

  3. Ueda M, Endo I, Nakashima M, et al. Prognostic factors after resection of pancreatic cancer. World J Surg. 2009;33:104–10.

    Article  Google Scholar 

  4. Tamburrino D, Riviere D, Yaghoobi M, Davidson BR, Gurusamy KS. Diagnostic accuracy of different imaging modalities following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer. Cochrane Database Syst Rev. 2016;9:CD011515

  5. Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6(1):149–63.

    Article  CAS  Google Scholar 

  6. Bergquist JR, Puig CA, Shubert CR, et al. Carbohydrate antigen 19–9 elevation in anatomically resectable, early stage pancreatic cancer is independently associated with decreased overall survival and an indication for neoadjuvant therapy: a National Cancer Database Study. J Am Coll Surg. 2016;223:52–65.

    Article  Google Scholar 

  7. Recio-Boiles A, Nallagangula A, Veeravelli S, et al. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios inversely correlate to clinical and pathologic stage in patients with resectable pancreatic ductal adenocarcinoma. Ann Pancreat Cancer. 2019;2:8.

    Article  Google Scholar 

  8. Giakoustidis A, Neofytou K, Costa Neves M, et al. Identifying the role of neutrophil-to-lymphocyte ratio and platelets-to-lymphocyte ratio as prognostic markers in patients undergoing resection of pancreatic ductal adenocarcinoma. Ann Hepatobiliary Pancreat Surg. 2018;22(3):197–207.

    Article  Google Scholar 

  9. Onoe S, Maeda A, Takayama Y, et al. The prognostic impact of the lymphocyte-to-monocyte ratio in resected pancreatic head adenocarcinoma. Med Princ Pract. 2019;28(6):517–25.

    Article  Google Scholar 

  10. Zhou Y, Cheng S, Fathy AH, et al. Prognostic value of platelet-to-lymphocyte ratio in pancreatic cancer: a comprehensive meta-analysis of 17 cohort studies. Onco Targets Ther. 2018;11:1899–908.

    Article  Google Scholar 

  11. Yang JJ, Hu ZG, Shi WX, et al. Prognostic significance of neutrophil to lymphocyte ratio in pancreatic cancer: a meta-analysis. World J Gastroenterol. 2015;21:2807–15.

    Article  Google Scholar 

  12. Mowbray NG, Griffith D, Hammoda M, Shingler G, Kambal A, Al-Sarireh B. A meta-analysis of the utility of the neutrophil-to-lymphocyte ratio in predicting survival after pancreatic cancer resection. HPB (Oxford). 2018;20(5):379–84.

    Article  Google Scholar 

  13. Buyukkaya E, Karakas MF, Karakas E, et al. Correlation of neutrophil to lymphocyte ratio with the presence and severity of metabolic syndrome. Clin Appl Thromb Hemost. 2014;20(2):159–63.

    Article  Google Scholar 

  14. Callery MP, Chang KJ, Fishman EK, Talamonti MS, William Traverso L, Linehan DC. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1727–33.

    Article  Google Scholar 

  15. Jamieson NB, Denley SM, Logue J, MacKenzie DJ, Foulis AK, Dickson EJ, et al. A prospective comparison of the prognostic value of tumor- and patient-related factors in patients undergoing potentially curative surgery for pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2011;18:2318–28.

    Article  Google Scholar 

  16. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144(5):646–74.

    Article  CAS  Google Scholar 

  17. Weitzman SA, Weitberg AB, Clark EP, Stossel TP. Phagocytes as carcinogens: malignant transformation produced by human neutrophils Science. 1985;227:1231–3.

    CAS  PubMed  Google Scholar 

  18. Man YG, Stojadinovic A, Mason J, et al. Tumor-infiltrating immune cells promoting tumor invasion and metastasis: existing theories. J Cancer. 2013;4:84–95.

    Article  Google Scholar 

  19. Jenne CN, Urrutia R, Kubes P. Platelets: bridging hemostasis, inflammation, and immunity. Int J Lab Hematol. 2013;35:254–61.

    Article  CAS  Google Scholar 

  20. Egan K, Crowley D, Smyth P, O'Toole S, Spillane C, Martin C, et al. Platelet adhesion and degranulation induce pro-survival and pro-angiogenic signalling in ovarian cancer cells. PLoS One 2011;6:e26125.

  21. Chawla A, Huang TL, Ibrahim AM, Hardacre JM, Siegel C, Ammori JB. Pretherapy neutrophil to lymphocyte ratio and platelet to lymphocyte ratio do not predict survival in resectable pancreatic cancer. HPB (Oxford). 2018;20(5):398–404.

    Article  Google Scholar 

  22. Garcea G, Ladwa N, Neal CP, Metcalfe MS, Dennison AR, Berry DP. Preoperative neutrophil-to-lymphocyte ratio (NLR) is associated with reduced disease-free survival following curative resection of pancreatic adenocarcinoma. World J Surg. 2011;35:868–72.

    Article  CAS  Google Scholar 

  23. Hamed MO, Roberts KJ, Smith AM, Morris SG. Elevated pre-operative neutrophil to lymphocyte ratio predicts disease free survival following pancreatic resection for periampullary carcinomas. Pancreatology. 2013;13(5):534–8.

    Article  CAS  Google Scholar 

  24. La Torre M, Nigri G, Cavallini M, Mercantini P, Ziparo V, Ramacciato G. The glasgow prognostic score as a predictor of survival in patients with potentially resectable pancreatic adenocarcinoma. Ann Surg Oncol. 2012;19:2917–23.

    Article  Google Scholar 

  25. Clark EJ, Connor S, Taylor MA, Madhavan KK, Garden OJ, Parks RW. Preoperative lymphocyte count as a prognostic factor in resected pancreatic ductal adenocarcinoma. HPB (Oxford). 2007;9:456–60.

    Article  CAS  Google Scholar 

  26. Sanjay P, de Figueiredo RS, Leaver H, Ogston S, Kulli C, Polignano FM, et al. Preoperative serum C-reactive protein levels and post-operative lymph node ratio are important predictors of survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. JOP. 2012;13:199–204.

    PubMed  Google Scholar 

  27. Stotz M, Gerger A, Eisner F, et al. Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer. Br J Cancer. 2013;109(2):416–21.

    Article  CAS  Google Scholar 

  28. Glazer ES, Rashid OM, Pimiento JM, Hodul PJ, Malafa MP. Increased neutrophil-to-lymphocyte ratio after neoadjuvant therapy is associated with worse survival after resection of borderline resectable pancreatic ductal adenocarcinoma. Surgery. 2016;160(5):1288–93.

    Article  Google Scholar 

  29. Sierzega M, Lenart M, Rutkowska M, et al. Preoperative neutrophil-lymphocyte and lymphocyte-monocyte ratios reflect immune cell population rearrangement in resectable pancreatic cancer. Ann Surg Oncol. 2017;24(3):808–15.

    Article  Google Scholar 

  30. Shrikhande SV, Shinde RS, Chaudhari VA, Kurunkar SR, Desouza AL, Agarwal V, Bhandare MS. Twelve Hundred Consecutive Pancreato-Duodenectomies from Single Centre: Impact of Centre of Excellence on Pancreatic Cancer Surgery Across India. World J Surg. 2020 Aug;44(8):2784-2793

  31. Aziz MH, Sideras K, Aziz NA, et al. The systemic-immuneinflammation index independently predicts survival and recurrence in resectable pancreatic cancer and its prognostic value depends on bilirubin levels: a retrospective multicenter cohort study. Ann Surg. 2018;270:139–46.

    Article  Google Scholar 

  32. Murthy P, Zenati MS, Al Abbas AI, et al. Prognostic value of the Systemic Immune-Inflammation Index (SII) after neoadjuvant therapy for patients with resected pancreatic cancer. Ann Surg Oncol. 2020;27(3):898–906.

    Article  Google Scholar 

  33. Jomrich G, Gruber ES, Winkler D, et al. Systemic Immune-Inflammation Index (SII) predicts poor survival in pancreatic cancer patients undergoing resection. J Gastrointest Surg. 2020;24(3):610–8.

    Article  Google Scholar 

  34. Bhatti I, Peacock O, Lloyd G, Larvin M, Hall RI. Preoperative hematologic markers as independent predictors of prognosis in resected pancreatic ductal adenocarcinoma: neutrophil-lymphocyte versus platelet-lymphocyte ratio. Am J Surg. 2010;200:197–203.

  35. Smith RA, Bosonnet L, Raraty M, Sutton R, Neoptolemos JP, Campbell F, et al. Preoperative platelet-lymphocyte ratio is an independent significant prognostic marker in resected pancreatic ductal adenocarcinoma. Am J Surg. 2009;197:466–72.

    Article  Google Scholar 

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Authors and Affiliations

  1. Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, Maharashtra, India

    Vikas Gupta, Vikram Chaudhari, Shailesh V. Shrikhande & Manish S. Bhandare

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  1. Vikas Gupta
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  2. Vikram Chaudhari
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  3. Shailesh V. Shrikhande
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Contributions

VG, MB VC, and SS were involved in the conception and design of the work. VG and MB are involved in acquisition, analysis, interpretation of data, and manuscript preparation. MB, VC, and SS are involved in manuscript editing, manuscript review. All authors read and approved the manuscript.

Corresponding author

Correspondence to Manish S. Bhandare.

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Ethical Approval

The data of the present study were collected in the course of common clinical practice, and accordingly, the signed informed consent was obtained from each patient for any surgical and clinical procedure. The study protocol was in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments. Because this was a retrospective study, formal consent for this study is not required, and no approval of the institutional research committee was needed.

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The authors declare no competing interests.

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Gupta, V., Chaudhari, V., Shrikhande, S.V. et al. Does Preoperative Serum Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), and Lymphocyte to Monocyte Ratio (LMR) Predict Prognosis Following Radical Surgery for Pancreatic Adenocarcinomas? Results of a Retrospective Study. J Gastrointest Canc 53, 641–648 (2022). https://doi.org/10.1007/s12029-021-00683-1

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