| PurposeThe study was aimed to reveal the prognostic significances of neutrophil-to-lymphocyte ratio(NLR)in patients with resectable pancreatic adenocarcinoma.MethodsA total of 389 patients with primary pancreatic adenocarcinoma who had undergone resection with curative intent between January 1,2008 and August 15,2015 in The First Affiliated Hospital of Nanjing Medical University were enrolled in this study and followed-up until December 20,2016.Among them,219 patients had definite recurrence record in our hospital.170 patients were followed up without formal follow-up,their survival results were followed by telephone,there was no clear recurrence or metastasis record of them.Therefore,219 patients with a definite recurrence or metastasis record were analyzed for recurrence-free survival,389 patients were analyzed for overall survival.The optimal cutoff value for the NLR was determined through X-tile software.The χ2 test or Fisher’s exact test was used to analyze the association between qualitative variables and NLR,while independent Student’s t-test was used for quantitative values.The survival curve was studied in Kaplan–Meier analyses by using the log-rank test.For multivariate analysis,the Cox regression model was used.R software was used to make a nomogram and calibration curve.ResultsNLR was higher in patients with T3-T4 and TNM stage II/III,and more patients with lower albumin levels were in the higher NLR group,higher NLR level was in patients with pancreatic head cancer and pancreatoduodenectomy.In the univariate analysis,an elevated preoperative NLR was significantly associated with decreased overall survival(OS)(13.7 months vs 22 months,p=0.001)and recurrence-free survival(RFS)(8.2 months vs 14.9 months,p=0.039),and this result remained significant in the multivariate analysis.Regard to OS,subgroup analyses showed that both patients with or without postoperative-chemotherapy can obtain in benefits from low NLR.Patients with stage I and II cancer can obtain OS and RFS benefits from low NLR,while patients with stage III cancer cannot.Regard to recurrence site,high NLR level was associated with distant metastasis(p=0.02).The number of cycles of adjuvant chemotherapy in the high NLR group was lower than that in the low NLR group,and the difference was statistically significant.Conclusion1.In the TNM stage I/II,the higher NLR predicted a shorter overall survival time and recurrence-free survival time.The effect of NLR on prognosis in TNM stage III patients was not statistically significant.2.Regardless of postoperative chemotherapy,higher NLR predicted shorter postoperative overall survival time.3.High NLR may be more prone to distant metastasis. |
