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Neutrophil to Lymphocyte RAtio COrrelates With PRe-OPerative CA 19-9 and PRedicts OVerall SUrvival in PAtients UNdergoing CUrative REsection for PAncreatic aDenocarcinoma.
Ioannis Hatzaras1, Antonio Masi*1, Marcovalerio Melis1, Antonio Pinna2, Steven Cohen1, Russell S. Berman1, H. Leon Pachter1, Elliot Newman1
1Surgery, NYU School of Medicine, New York, NY; 2Surgery, University of Sassari, Sassari, Italy
Methods: Our pancreatic cancer database was queried for patients undergoing resection. Relationship of LNR and Ca 19-9 was examined. Overall survival (OS) analysis and multivariate Cox proportional hazards regression were used to assess the independent effect of NLR.
Results: There were 273 patients who underwent curative intent pancreatic resection for adenocarcinoma (1990-2011). Median age was 70 (range: 37-90); 52% were female. Median NLR was 3 (range: 0.5 - 14.5); median Ca19-9 was 52U/ml (range: 3 - 28,000). The majority of patients (223, 82%) underwent pancreticoduodenectomy, had N1-disease (170, 64%) and margin-negative resection (217, 86%). The 30-day mortality was 1%. OS was 17.5 months, with 2 and 5-year survival at 40% and 21% respectively. We found no relationship between NLR and other indicators of poor biologic behavior, such as lymph node metastasis, neural or lymphovascular invasion. However elevated NLR correlated with high pre-operative Ca 19-9 (p=0.002) and decreased OS (p=0.009). Multivariate analysis confirmed that NLR is an independent predictor of Ca 19-9 (0.001) and OS (0.009).
Conclusions: NLR's strong correlation with Ca 19-9 and decreased OS suggests that patients with elevated NLR may have subclinical disease at time of diagnosis. Further study is needed to establish its efficacy as a risk stratification tool in prospective therapeutic trials.
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