Neutrophil to lymphocyte ratio, not platelet to lymphocyte or lymphocyte to monocyte ratio, is predictive of patient survival after resection of early-stage pancreatic ductal adenocarcinoma
David T. Pointer,
David Roife,
Benjamin D. Powers,
Gilbert Murimwa,
Sameh Elessawy,
Zachary J. Thompson,
Michael J. Schell,
Pamela J. Hodul,
Jose M. Pimiento,
Jason B. Fleming,
Mokenge P. Malafa
Affiliations
David T. Pointer
Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute
David Roife
Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute
Benjamin D. Powers
Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute
Gilbert Murimwa
Department of Surgery, University of Texas Southwestern
Sameh Elessawy
Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute
Zachary J. Thompson
Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute
Michael J. Schell
Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute
Pamela J. Hodul
Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute
Jose M. Pimiento
Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute
Jason B. Fleming
Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute
Mokenge P. Malafa
Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute
Abstract Background NLR, PLR, and LMR have been associated with pancreatic ductal adenocarcinoma (PDAC) survival. Prognostic value and optimal cutpoints were evaluated to identify underlying significance in surgical PDAC patients. Methods NLR, PLR, and LMR preoperative values were available for 277 PDAC patients who underwent resection between 2007 and 2015. OS, RFS, and survival probability estimates were calculated by univariate, multivariable, and Kaplan-Meier analyses. Continuous and dichotomized ratio analysis determined best-fit cutpoints and assessed ratio components to determine primary drivers. Results Elevated NLR and PLR and decreased LMR represented 14%, 50%, and 50% of the cohort, respectively. OS (P = .002) and RFS (P = .003) were significantly decreased in resected PDAC patients with NLR ≥5 compared to those with NLR < 5. Optimal prognostic OS and RFS cutpoints for NLR, PLR, and LMR were 4.8, 192.6, and 1.7, respectively. Lymphocytes alone were the primary prognostic driver of NLR, demonstrating identical survival to NLR. Conclusions NLR is a significant predictor of OS and RFS, with lymphocytes alone as its primary driver; we identified optimal cutpoints that may direct future investigation of their prognostic value. This study contributes to the growing evidence of immune system influence on outcomes in early-stage pancreatic cancer.