Prognostic value of blood neutrophil-to-lymphocyte ratio (NLR)in advanced pancreatic cancer patients treated with Nab-paclitaxel and Gemcitabine: our experience

Abstract

Background: A high neutrophil to lymphocyte ratio (NLR) is a strong predictor of poor survival in many tumors. Therefore in our study we have valuated the prognostic value of pretreatment NLR in a cohort of patients with advanced pancreatic cancer treated with Nab‐paclitaxel and Gemcitabine. Methods: From January 2012 to January 2015, 47 patients with metastatic pancreatic adenocarcinoma (mPDAC) were evaluated for analysis. NLR was calculated from lymphocyte and neutrophil counts on routine blood tests taken before chemotherapy. Survival analyses were generated according to the Kaplan‐Meier method. Univariate and multivariate analyses were carried out by the Cox proportional hazard model. Results: Median age of patients was 67 (range 41‐77), 11 pts had an age ≥ 70 and, ECOG PS was 0‐1 in 32 pts and 2 in 9 pts. Primary tumor was located to pancreatic head or body‐tail in 24 (58.5%) and 17 (41.5%) pts respectively. Metastatic sites were represented by liver (60.9%), nodes (24.3%), lung (21.9%), peritoneum (9.75%) and bone (2.4%). Nine patients had received biliary stent implantation before starting chemotherapy. Median CA19.9 levels at baseline was 469 U/I (range 17,4‐61564 U/I). These patients were divided into two groups according to NLR cut‐off of 5: high (≥5.0) and low (<5.0). A low NLR pre‐treatment was observed in 29 patients while high level of NLR was observed in 12 patients. Median Progression free survival (PFS) of patients with low NLR was 8 months (95%CI: 6.9‐9.0) compared with 3 months of patients with a high NLR(95%CI: 0.8‐5.1) (p: 0.005). Median Overall survival (OS) was 12 months (95%CI: 9.3‐14.6) in patients with low NLR compared with 7 months (95%CI: 3.8‐10.1) of patients with high NLR ( p: 0.0001). On multivariate analysis, after adjusting for other clinic‐pathologic factors, high NLR turned out to be an independent risk factor for poor survival (p = 0.001). Conclusions: Our results suggest that an elevated pre‐treatment NLR (≥ 5) is an independent prognostic factor correlated to a poor PFS and OS in metastatic pancreatic cancer treated with Nab‐paclitaxel and Gemcitabine. Furthermore these results justify the use of NLR as a prognostic factor for risk stratification in future studies.