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Exploring the Prognostic Value of Platelet-to-Lymphocyte Ratio (PLR) After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A 14-Year Single-Center Experience
Ahmed I. Salem*, Emily R. Winslow, Clifford S. Cho, Sharon M. Weber
General Surgery, University of Wisconsin, Madison, WI
Introduction:
Platelet-to-lymphocyte ratio (PLR) has been introduced as a serological marker with a potential prognostic role for many cancer types. The role of PLR in predicting outcome for pancreas cancer is understudied. Previous reports have suggested that higher PLRs are associated with worse survival. We sought to investigate the relation between PLR and both short and long term outcomes after pancreatic ductal adenocarcinoma resection in our institution.
Methods:
Patients with pancreas cancer who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma between 1999 and 2012 were evaluated. PLR was calculated by dividing the absolute platelet count value by the absolute lymphocytic count value. We identified 216 patients from our prospectively maintained database with 111 patients excluded for lack of data on platelet or lymphocytic counts within 30 days prior to surgery. Out of the 105 eligible patients analyzed, 23 (22%) had PLR ≥ 240.
Results:
There was no difference in 30-day mortality between patients with PLR ≥ 240 and those with PLR < 240 (0 (0%) vs 1 (1.2%), p=0.6) and no difference in overall 30-day morbidity (15 (65%) vs 44 (54%), p=0.3). Patients with PLR < 240 were more likely to have nodal metastases than their counterpart group (67 (82%) vs 13 (57%), p=0.01), while patients with PLR ≥ 240 had a higher median estimated blood loss (EBL) (400 mL (150-12,500) vs 500 mL (150-1,400), p=0.04) and a higher median number of intraoperatively-transfused packed red cell units (2 units (0-23) vs 0 units (0-9), p=0.005). More patients in the PLR ≥ 240 group received neoadjuvant therapy (9 (39%) vs 8 (10%), p=0.001) while less patients in the same group received adjuvant therapy (12 (52%) vs 61 (74%), p=0.04) (Table.1). Kaplan-Meier survival analysis showed improved median overall survival in the PLR ≥ 240 group (20 months (10-29) vs 20 months (15-25), p=0.03). On multivariable analysis, after adjusting for nodal status, EBL, intraoperative packed red cell transfusion, adjuvant and neoadjuvant therapy, PLRs ≥ 240 were found to be significant predictors of improved overall survival (HR=0.47, CI=0.23 - 0.95, p=0.04).
Conclusion
In our institutional experience of pancreas cancer patients undergoing pancreaticoduodenectomy, elevated PLR was associated with an increased risk of EBL and need for transfusion, but improved long-term survival. This is in contrast to previous reports describing elevated PLR as a negative prognostic variable. Further studies on larger numbers of patients are required to better assess the prognostic role of preoperative PLR for both short and long-term outcomes after curative resection of pancreas cancer.
Table 1. Univariable Analysis of Therapeutic, Surgical and Pathological Features Stratified by PLR at a Cut of Point of 240 in 105 Patients Undergoing pancreaticoduodenectomy for Pancreatic Adenocarcinoma.
| Factors | n (%) | p Value | PLR ≥ 240
23(22) | PLR < 240
82(78) | | Therapeutic Features: | | • Neoadjuvant Therapy | 9(39) | 8(10) | 0.001 | | • Adjuvant Therapy | 12(52) | 61(74) | 0.04 | | Surgical Features: | | • EBL§ (mL; median, range) | 400(150-12,500) | 500(150-1,400) | 0.04 | | • Transfusion Units (unit; median, range) | 2(0-23) | 0(0-9) | 0.005 | | Pathological Features: | | Lymph Node Positivity | 13(57) | 67(82) | 0.01 | |
§EBL, Estimated Blood Loss.  Figure 1. Multivariable Cox-regression Hazards Analysis Adjusting for Nodal Status, EBL, intraoperative packed red cell transfusion, adjuvant and neoadjuvant therapy.
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