Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index as clinical predictive and prognostic markers in patients with advanced pancreatic cancer receiving gemcitabine monotherapy

Abstract

Introduction. Pancreatic cancer is characterized by an increasing incidence and still poor prognosis despite the availability of various therapeutic options, currently including single- and multi-drug chemotherapy as well as molecularly targeted therapy. Therefore, appropriate qualification for particular therapies, based mainly on clinical and histological factors, is extremely important. Inflammatory status, associated with cancer development, justifies the search for prognostic markers related to the immune system, which could be additional factors facilitating selection of appropriate therapy. This study aimed at assessing the prognostic value of the neutrophil-to-lymphocyte ratio (NLR), plateletto- lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) in patients with advanced pancreatic cancer undergoing gemcitabine monotherapy. 

Material andmethods. A retrospective analysis of blood morphological parameters was performed in 167 patients with advanced pancreatic cancer treated with gemcitabine monotherapy in the first line in five oncology centers in Poland in the years 2017–2022. The NLR, PLR, and SII were calculated, and cut-off points between high and low values were defined. Clinical parameters and their distribution were assessed depending on the overall survival (OS) value equal to or greater than or less than median OS. The distribution of patients within OS intervals in relation to the categories of inflammatory markers was assessed. 

Results. The median age of patients was 71 years, the majority were women (58%), with clinical stage IV (57%), and with dominant location of metastases in the liver (42.5%). The median NLR was 2.69 (range 0.5–36.65), PLR 146.54 (range 18.53–1118.57), and SII 784.75 (range 79.86–10622.67). The cut-off points were defined as 4.5625 for the NLR [125 patients (75.8%) with a value less than and 40 patients (24.3%) with a value equal to or greater], 150 for the PLR [87 (52.7%)/ 78 (47.3%)], and 897.619 for the SII [96 (58.2%)/69 (41.8%)]. Comparing the groups with OS longer than or equal to the median and OS shorter than the median, statistically significant differences were found in relation to body mass index (BMI) (p = 0.02), baseline stage (p < 0.001), and location of metastases (p < 0.001). There were statistically significantly more NLR and SII values below the cut-off points in patients with survival at least equal to median OS. Concerning the PLR, no statistically significant differences were found between groups determined by OS value. 

Conclusions. We demonstrated the relationship between indicators calculated on the basis of blood count parameters and treatment results. It may indicate the predictive and prognostic importance of indices reflecting immune system status, which can be a valuable addition to the clinical criteria included in prognostic models.