Prognostic Performance Of Inflammation-based Prognostic Indices In Patients With Pancreatic Ductal Adenocarcinoma

Objective:To validate the prognostic relevance of pretreatment hematological markers of inflammatory response in cohort of patients with pancreatic ductal adenocarcinoma (PDAC).Method:In the first part, data were collected retrospectively for patients with resectable PDAC visiting Chinese PLA General Hospital from January 2007 to July 2014. Patients were stratified into quartile of the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR) and prognostic nutritional index (PNI), respectively.Multivariable Cox regression was used to determine the independent prognostic significance of the above inflammatory biomarkers. In the second part, a total of 374 consecutive patients with pathologically-comfirmed locally advanced or metastatic PDAC were retrospectively recruited between January 2006 and July 2015.Cutoff values were calculated by ROC curve analysis.NLR and PLR were analyzed in this part. Cox regression was also performed to evaluate the prognostic factors.Results:In the first part, multivariate analysis revealed that NLR (DFS:P<0.001, HR:1.654,95%CI:1.404-1.949; OS:P<0.001,HR:1.667,95%CI:1.402-1.982), PLR(DFS:P<0.001,HR:1.503,95%CI:1.296-1.740;OS:P<0.001,HR:1.58,95%C1: 1.341-1.861),LMR(DFS:P<0.001,HR:0.674,95%CI:0.582-0.781;OS:P<0.001,HR:0.6 4,95%CI:0.546-0.754)and PNI(DFS:P=0.003,HR:0.816,95%CI:0.713-0.933; OS.P=0.014,HR:0.843,95%CI:0.735-0.966)were independent prognostic factors in patients with resectable PDAC. In the second part, the cutoff values of 4 for the NLR,150 for the PLR was chosen as optimal to discriminate patients’ survival in the whole cohort by applying receiver operating curves analysis. Multivariate analysis showed that pretreatment NLR (P<0.001,HR:2.922,95%CI:2.195-3.891), along with pretreatment PLR (P<0.001,HR:1.665,95%CI:1.276-2.171)was an independent prognostic factor of overall survival in patients with locally advanced or metastatic PDAC.Patients with elevated NLR or PLR both before first-line chemotherapy and at the 2th cycles had the worst prognosis.Conclusion:Preoperative NLR, PLR,LMR and PNI are independent prognostic factors of survival in patients underwent resection for PDAC.Pretreatment.NLR>4 and PLR>150 may represent negative prognostic factors in patients with locally advanced or metastatic PDAC who receive first-line chemotherapy.