title: Neutrophil/lymphocyte ratio as a prognostic factor in biliary tract cancer.
abstract: BACKGROUND
  Biliary tract cancers (BTCs) include intrahepatic (IHC), hilar, distal bile duct (DBD) and gallbladder carcinoma (GBC). Neutrophil/lymphocyte ratio (NLR), a marker of host inflammation, is prognostic in several cancers but has not been reviewed in large BTC series, or advanced BTC (ABTC) at diagnosis.
  
  
  METHODS
  Baseline demographics and NLR at diagnosis were retrospectively evaluated in 864 consecutive patients with BTC treated from January 1987 to December 2012. The association between NLR and overall survival (OS) was determined using a multivariable Cox proportional hazards model.
  
  
  RESULTS
  Eight hundred and sixty-four patients were included in the analysis, of which 62% had ABTC and 38% had surgery with curative intent. Median age was 65 years, 444 (51%) were male and 727 (84%) had performance status (PS) ⩽ 2. A NLR ⩾ 3.0, PS >2, IHC primary, stage, lack of surgery, haemoglobin <110 g/L and albumin <40 g/L were associated with significantly worse OS on multivariable analysis. A NLR ⩾ 3.0 was an independent prognostic factor for OS for the entire cohort; median OS was 21.6 months versus 12.0 months for patients with NLR <3.0 versus NLR ⩾ 3.0 respectively (adjusted hazard ratio (HR)-1.26, 95% confidence interval (CI); 1.06-1.50, P = 0.01). NLR was also prognostic in patients with ABTC (HR-1.26, 95% CI; 1.02-1.56, P = 0.035) and hilar cancer: overall group (N = 149) (HR-1.70, 95% CI; 1.10-2.50, P = 0.01) and advanced group (N = 111) (HR-1.57, 95% CI; 1.04-2.44, P = 0.048).
  
  
  CONCLUSIONS
  Baseline NLR is a readily available and inexpensive prognostic biomarker in patients with BTC and likely warrants validation in large prospective clinical trials.
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: M G
authors.initials: MG
authors.lastname: McNamara
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: A J
authors.initials: AJ
authors.lastname: Templeton
authors.affiliation: Department of Biostatistics, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Maganti
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada; Department of Gastroenterology, Edouard Herriot Hospital, 5 place d'Arsonval, 69003 Lyon, France.
authors.forename: T
authors.initials: T
authors.lastname: Walter
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada; Department of Medical Oncology, Waterford Regional Hospital, Waterford, Ireland.
authors.forename: A M
authors.initials: AM
authors.lastname: Horgan
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: L
authors.initials: L
authors.lastname: McKeever
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Min
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Amir
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada. Electronic address: jennifer.knox@uhn.on.ca.
authors.forename: J J
authors.initials: JJ
authors.lastname: Knox
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001661:Biliary Tract Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D001662:Biliary Tract Surgical Procedures / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Biliary tract cancer; Neutrophil/lymphocyte ratio; Prognosis