A. I. Salem1, E. R. Winslow1, C. S. Cho1, S. M. Weber1 1University Of Wisconsin School Of Medicine And Public Health,General Surgery,Madison, WI, USA
Introduction:
Neutrophil-to-lymphocyte ratio (NLR) has been introduced as a serological marker with a potential prognostic role for many cancer types. The role of NLR in predicting pancreas cancer outcome is understudied. Previous reports have suggested that higher NLRs are associated with worse survival. We sought to investigate the relation between NLR and both short and long term outcomes after pancreatic ductal adenocarcinoma resection in our institution.
Methods:
Patients with pancreas cancer who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma between 1999 and 2012 were evaluated. NLR was calculated by dividing the absolute neutrophilic count value by the absolute lymphocytic count value. We identified 216 patients from our prospectively maintained database with 104 patients excluded for lack of data on neutrophilic or lymphocytic counts within 30 days prior to surgery. Out of 112 eligible patients analyzed, 33 (29.5%) had NLR ≥ 4.5.
Results:
There was no difference in 30-day mortality between patients with NLR ≥ 4.5 and those with NLR < 4.5 (0 (0%) vs 1 (1.3%), p=0.5) and no differences in overall 30-day morbidity (16 (49%) vs 45 (57%), p=0.4). Patients with NLR < 4.5 were more likely to have nodal metastases than their counterpart group (69 (87%) vs 16 (49%), p<0.001), while patients with NLR ≥ 4.5 had a higher median estimated blood loss (EBL) (550 mL (150-12,500) vs 500 mL (150-1,400), p=0.02), a higher median number of intraoperatively-transfused packed red cell units (2 units (0-23) vs 0 units (0-9), p=0.01), and a longer hospital stay (LOS) (10 days (5-39) vs 8 days (4-35), p=0.04). Kaplan-Meier survival analysis showed improved median overall survival in the NLR ≥ 4.5 group (21 months vs 18 months, p=0.02). On multivariable analysis, after adjusting for nodal status, EBL, intraoperative packed red cell transfusion, NLRs ≥ 4.5 were found to be the only predictor of improved overall survival (HR=0.54 , CI=0.30 – 0.97, p=0.04) (Figure.1).
Conclusion:
In our experience of pancreas cancer patients undergoing pancreaticoduodenectomy, elevated NLR was associated with an increased risk of EBL, need for transfusion, and longer LOS, but improved long-term survival. This is in contrast to previous reports describing elevated NLR as a negative prognostic variable. Further studies on larger numbers of patients are required to better assess the prognostic role of preoperative NLR for both short and long-term outcomes after curative resection of pancreas cancer.
