Elevated pre-operative neutrophil to lymphocyte ratio predicts disease free survival following pancreatic resection for periampullary carcinomas.
BACKGROUND
The pre-operative neutrophil-to-lymphocyte ratio (NLR), when ≥5 has been associated with reduced survival for patients with various gastrointestinal tract cancers, however, it's prognostic value in patients with periampullary tumour has not been reported to date.


OBJECTIVE
To determine the prognostic value of pre-operative NLR in terms of survival and recurrence of resected periampullary carcinomas.


METHODS
This was a retrospective cohort study of consecutive patients undergoing pancreatoduodenectomy (PD) for periampullary carcinoma (pancreatic, ampullary, cholangiocarcinoma) identified from a departmental database. The effect of NLR upon survival and recurrence was explored.


RESULTS
Overall median survival amongst 228 patients was 24 months (inter-quartile range [IQR]: 12-43). The median survival for those whose NLR was <5 was not significantly greater than those patients whose NLR was ≥5 (24 months [IQR: 14-42] versus 13 months [IQR: 8-48], respectively; p = 0.234). However, for those that developed recurrence, survival was greater in those with an NLR <5 at (20 months [IQR: 12-27] versus 11 months [IQR: 7-22], respectively; p = 0.038). This effect was most marked in those patients with cholangiocarcinoma (p = 0.019) whilst a trend to worse survival was seen in those with pancreatic adenocarcinoma. No effect was seen in patients with ampullary carcinoma (p = 0.516).


CONCLUSIONS
This study provides further evidence that pre-operative NLR offers important prognostic information regarding disease-free survival. This effect, however, is dependent upon the tumour type amongst patients undergoing PD.
The Pancreatic Unit, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
Mazin O
MO
Hamed
Keith J
KJ
Roberts
Andrew M
AM
Smith
Gareth
G
Morris Stiff
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery; D000368:Aged; D018281:Cholangiocarcinoma / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009504:Neutrophils / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D012189:Retrospective Studies
Disease-free survival; Neutrophil–lymphocyte ratio; Pancreatoduodenectomy; Periampullary carcinoma