Purpose/Objective(s): Recently, the neutrophil-to-lymphocyte ratio (NLR) has been shown to predict prognosis in multiple different tumor types, such as non-small cell lung cancer, colorectal cancer and ovarian cancer. In metastatic pancreatic cancer and locally advanced unresectable pancreatic cancer, a high pre-treatment NLR as well as a continued high post-treatment NLR is also associated with a poorer prognosis. The prognostic significance of NLR in the setting of BRPC patients treated with neoadjuvant chemotherapy followed by stereotactic body radiation therapy (SBRT) has not been reported and could have a role in patient selection for surgery post treatment. Materials/Methods: An IRB-approved retrospective review of outcomes in 78 patients with borderline resectable pancreatic cancer receiving neoadjuvant gemcitabine based chemotherapy for 2-3 cycles followed by a 5 fraction regimen of stereotactic body radiation therapy was completed. The SBRT was delivered with focal dose escalation to the tumor/borderline vessel interface (median 35 Gy). Pre-SBRT and post-SBRT neutrophil/lymphocyte ratios were calculated. The relationship of NLR to overall survival (OS) and disease-free survival (DFS) was examined. Results: The median pre SBRT NLR was 2.82 and the median post SBRT NLR was 3.6. Post treatment, 29/71 (40.8%) had a decrease in NLR showing improvement. A post-SBRT NLR > 5 was associated with a significantly decreased overall survival (PZ0.004, HRZ3.851) while an NLR < 3.6 significantly increased overall survival (P = 0.044, HR = 2.353). Disease free survival, pre-treatment values, and absolute NLR value change were not significant. Conclusion: A high post-SBRT NLR (>5) is associated with a poorer prognosis in patients with BRPC undergoing neoadjuvant therapy with neoadjuvant gemcitabine based chemotherapy followed by 5 fraction SBRT. A low post-SBRT (<3.5) NLR was associated with a longer overall survival. Although further confirmation in prospective trials is needed, our data suggests that post SBRT NLR may be a useful prognostic biomarker to select patients for consideration of surgery versus further systemic therapy.
Pearson, A. L., Jin, W., Mellon, E. A., Frakes, J. M., Strom, T., Springett, G. M., … Hoffe, S. E. (2016). Post-Stereotactic Body Radiation Therapy (SBRT) Neutrophil-to-Lymphocyte Ratio (NLR) in Patients With Borderline Resectable Pancreatic Cancer (BRPC) May Be a Prognostic Biomarker. International Journal of Radiation Oncology*Biology*Physics, 96(2), E153. https://doi.org/10.1016/j.ijrobp.2016.06.974