title: Preoperative neutrophil-to-lymphocyte ratio (NLR) is associated with reduced disease-free survival following curative resection of pancreatic adenocarcinoma.
abstract: BACKGROUND
  Serological proinflammatory markers such as C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) have been associated with reduced survival for many different types of cancer. This study determined the prognostic value of the preoperative value of these markers in patients with resectable pancreatic adenocarcinoma.
  
  
  METHODS
  Consecutive patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma were entered into our database from 2001 to the present day. CRP, NLR, and PLR at the time of presentation were recorded as well as overall and disease-free survival.
  
  
  RESULTS
  Seventy-four patients were identified. Overall median survival was 35.0 months and median disease-free survival was 27.0 months. Follow-up ranged from 1 to 125.8 months. Preoperative NLR was significantly greater in those patients who developed recurrence in the follow-up period (4.5 vs. 3.1). CRP and PLR were not found to differ significantly between the two groups. Kaplan-Meier survival analysis of patients with NLR > 5 demonstrated a disease-free survival of 12 months compared with 52 months for those patients with NLR < 5 (p < 0.001).
  
  
  CONCLUSIONS
  Preoperative NLR offers important prognostic information regarding disease-free survival following curative resection of pancreatic ductal adenocarcinoma.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, LE5 4PW, UK. gg43@le.ac.uk
authors.forename: G
authors.initials: G
authors.lastname: Garcea
authors.forename: N
authors.initials: N
authors.lastname: Ladwa
authors.forename: C P
authors.initials: CP
authors.lastname: Neal
authors.forename: M S
authors.initials: MS
authors.lastname: Metcalfe
authors.forename: A R
authors.initials: AR
authors.lastname: Dennison
authors.forename: D P
authors.initials: DP
authors.lastname: Berry
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000401:mortality* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009504:Neutrophils / Q000378:metabolism*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000401:mortality* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers