Affiliations: [a] Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy | [b] San Raffaele Roma Open University, Rome, Italy | [c] Interinstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, Rome, Italy | [d] Department of Systems Medicine, Internal Medicine, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy | [e] Section of Medical Oncology, Department of Surgical and Oncology Sciences, University of Palermo, Italy
Correspondence:
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Corresponding author: Vincenzo Formica, Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Viale Oxford, 81-00133 Rome, Italy. Tel.: +39 0620908190; Fax: +39 0620903806; E-mail: [email protected]
Abstract: BACKGROUND:
High Neutrophil/Lymphocyte ratio (NLR), as a measure of enhanced
inflammatory response, has been negatively associated with prognosis in
patients with localized pancreatic ductal adenocarcinoma (PDA).
OBJECTIVE:
In the present study, we aimed at investigating the prognostic value of NLR
in two homogeneous groups of chemotherapy-naïve metastatic PDA
patients. Patients were treated with either gemcitabine (GEM) or
gemcitabine/oxaliplatin (GEMOXA). We also assessed whether NLR could identify
patients benefiting from the use of oxaliplatin.
METHODS:
Consecutive PDA patients treated at the Medical Oncology Unit of Tor
Vergata University Hospital of Rome with either GEM or GEMOXA were included
(n= 103). NLR was assessed before and during chemotherapy and correlated with
outcome together with common clinical and biochemical variables.
RESULTS:
Among 17 analyzed variables NLR, Karhofsky Perfomance Status (KPS), d-dimer
and erythrocyte sedimentation rate were found to be significantly associated
with median Overall Survival (mOS) at the univariate analysis. Only NLR and
KPS were independent prognosticator at multivariate analysis, with NLR
displaying the highest statistical significance. NLR was also predictive of
oxaliplatin activity, as only patients with NLR > 2.5 (cutoff determined upon
ROC analysis) derived benefit from GEMOXA over GEM.
CONCLUSIONS:
NLR is both an independent prognostic and predictive factor in metastatic
PDA, since only patients with high NLR seem to benefit from the addition of
oxaliplatin. NLR may help select patients for whom a particularly poor
prognosis might justify more intensive, yet less tolerable, combination
regimens.
