Vol 73, No 2 (2023)
Research paper (original)
Published online: 2023-02-23

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Neutrophil-to-lymphocyte ratio as a prognostic factor in patients during palliative treatment of pancreatic ductal adenocarcinoma with a FOLFIRINOX regimen

Małgorzata Domagała-Haduch1, Jakub Wnuk1, Łukasz Michalecki1, Iwona Gisterek1
Nowotwory. Journal of Oncology 2023;73(2):59-62.


Introduction.Difficulties in advanced pancreatic ductal adenocarcinoma (PDAC) treatment require a constant search for novel prognostic factors. The aim of this study is to determine the role of various morphological parameters in pre­dicting the prognosis of advanced PDAC during systemic therapy with a FOLFIRINOX regimen.

Material and methods.The data of 52 patients, treated with FOLFIRINOX chemotherapy due to metastatic PDAC were analyzed retrospectively in this study.

Results.The median time of overall survival (OS) in the group of patients with neutrophil-to-lymphocyte ratio (NLR) ≥3 was 5.8 months, compared to 14.5 months in patients with NLR < 3. Median progression-free survival (PFS) in patients with NLR ≥ 3 was 4.1 months, compared to 8.5 months in patients with NLR < 3. There were no statistically significant differences among patients concerning the lymphocyte-to-monocyte ratio (LMR) and platelets-to-lymphocyte ratio (PLR).

Conclusions.Higher NLR is a negative prognostic factor in metastatic PDAC.

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  1. Rahib L, Smith BD, Aizenberg R, et al. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014; 74(11): 2913–2921.
  2. Didkowska J, Wojciechowska U. Zachorowania i zgony na nowotwory złośliwe w Polsce. Krajowy Rejestr Nowotworów, Centrum Onkologii - Instytut im. Marii Skłodowskiej - Curie. http://onkologia.org.pl/raporty/ (12.05.2018).
  3. Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer . N Engl J Med. 2018; 37(25): 2395–2406.
  4. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Pancreatic Adenocarcinoma Version 2.2022. https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf.
  5. Ducreux M, Cuhna ASa, Caramella C, et al. ESMO Guidelines Committee. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015; 26 Suppl 5: v56–v68.
  6. Conroy T, Desseigne F, Ychou M, et al. Groupe Tumeurs Digestives of Unicancer, PRODIGE Intergroup. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011; 364(19): 1817–1825.
  7. Sahoo RK, Kumar L, Saltz LB, et al. Albumin-bound paclitaxel plus gemcitabine in pancreatic cancer. N Engl J Med. 2014; 370(5): 479–480.
  8. Neesse A, Algül H, Tuveson DA, et al. Stromal biology and therapy in pancreatic cancer: a changing paradigm. Gut. 2015; 64(9): 1476–1484.
  9. Chang J, Jiang Y, Pillarisetty V. Role of immune cells in pancreatic cancer from bench to clinical application: An updated review. Medicine. 2016; 95(49): e5541.
  10. Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014; 106(6): dju124.
  11. Krakowska M, Dębska-Szmich S, Czyżykowski R, et al. The prognostic impact of neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio in patients with advanced colorectal cancer treated with first-line chemotherapy. Prz Gastroenterol. 2018; 13(3): 218–222.
  12. Mantovani A, Allavena P, Sica A, et al. Cancer-related inflammation. Nature. 2008; 454(7203): 436–444.
  13. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010; 140(6): 883–899.
  14. Lin WW, Karin M. A cytokine-mediated link between innate immunity, inflammation, and cancer. J Clin Invest. 2007; 117(5): 1175–1183.
  15. Antonio N, Bønnelykke-Behrndtz ML, Ward LC, et al. The wound inflammatory response exacerbates growth of pre-neoplastic cells and progression to cancer. EMBO J. 2015; 34(17): 2219–2236.
  16. Houghton AM, Rzymkiewicz DM, Ji H, et al. Neutrophil elastase-mediated degradation of IRS-1 accelerates lung tumor growth. Nat Med. 2010; 16(2): 219–223.
  17. Fridlender ZG, Sun J, Kim S, et al. Polarization of tumor-associated neutrophil phenotype by TGF-beta: ‘N1’ versus ‘N2’ TAN. Cancer Cell. 2009; 16(3): 183–194.
  18. Iwai N, Okuda T, Sakagami J, et al. Neutrophil to lymphocyte ratio predicts prognosis in unresectable pancreatic cancer. Sci Rep. 2020; 10(1): 18758.
  19. Pointer DT, Roife D, Powers BD, et al. 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. BMC Cancer. 2020; 20(1): 750.
  20. Luo G, Guo M, Liu Z, et al. Blood neutrophil-lymphocyte ratio predicts survival in patients with advanced pancreatic cancer treated with chemotherapy. Ann Surg Oncol. 2015; 22(2): 670–676.
  21. Piciucchi M, Stigliano S, Archibugi L, et al. The Neutrophil/Lymphocyte Ratio at Diagnosis Is Significantly Associated with Survival in Metastatic Pancreatic Cancer Patients. Int J Mol Sci. 2017; 18(4).
  22. Shusterman M, Jou E, Kaubisch A, et al. The Neutrophil-to-Lymphocyte Ratio is a Prognostic Biomarker in An Ethnically Diverse Patient Population with Advanced Pancreatic Cancer. J Gastrointest Cancer. 2020; 51(3): 868–876.
  23. Cetin S, Dede I. Prognostic value of the neutrophil-to-lymphocyte ratio and carbohydrate antigen 19-9 in estimating survival in patients with metastatic pancreatic cancer. J Cancer Res Ther. 2020; 16(4): 909–916.
  24. Zhou Y, Wei Q, Fan J, et al. Prognostic role of the neutrophil-to-lymphocyte ratio in pancreatic cancer: A meta-analysis containing 8252 patients. Clin Chim Acta. 2018; 479: 181–189.
  25. 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(9): 2807–2815.
  26. Hu RJ, Ma JY, Hu G. Lymphocyte-to-monocyte ratio in pancreatic cancer: Prognostic significance and meta-analysis. Clin Chim Acta. 2018; 481: 142–146.
  27. Li W, Tao L, Zhang L, et al. Prognostic role of lymphocyte to monocyte ratio for patients with pancreatic cancer: a systematic review and meta-analysis. Onco Targets Ther. 2017; 10: 3391–3397.
  28. 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: 1899–1908.
  29. Li W, Tao L, Lu M, et al. Prognostic role of platelet to lymphocyte ratio in pancreatic cancers: A meta-analysis including 3028 patients. Medicine (Baltimore). 2018; 97(8): e9616.
  30. El-Ashwah S, Denewer M, Niazy N, et al. Low platelet to lymphocyte ratio and high platelet distribution width have an inferior outcome in chronic lymphocytic leukaemia patients. Nowotwory. Journal of Oncology. 2020; 70(4): 121–126.

Nowotwory. Journal of Oncology