title: Postoperative peripheral absolute blood lymphocyte-to-monocyte ratio predicts therapeutic outcome after pancreatic resection in patients with pancreatic adenocarcinoma.
abstract: OBJECTIVE
  The aim of this study was to evaluate the significance of postoperative peripheral absolute blood lymphocyte-to-monocyte (ALC/AMC) ratio in pancreatic resections for pancreatic carcinoma.
  
  
  METHODS
  One hundred eleven patients who underwent pancreatic resection for pancreatic carcinoma were included in this study. We retrospectively examined perioperative findings as predictors of therapeutic outcome and the relation between postoperative ALC/AMC ratio and recurrence rate as well as overall survival of the patients with pancreatic carcinoma.
  
  
  RESULTS
  In univariate analysis, advanced tumor-node-metastasis (TNM) classification (p=0.0002), intraoperative flesh-frozen plasma (FFP) transfusion (p=0.0395), increased in preoperative serum carbohydrate antigen 19-9 (CA19-9) (p=0.0051) and lower postoperative ALC/AMC ratio (p=0.0007) were positively associated with poor disease-free survival. Advanced TNM classification (p=0.0008), intraoperative FFP transfusion (p=0.0343), elevated postoperative serum C-reactive protein (CRP) (p=0.0165) and lower postoperative ALC/AMC ratio (p=0.0029), as well as decreased preoperative lymphocyte counts (p=0.0248) were positively associated with poor overall survival. In multivariate analysis, advanced TNM classification (p=0.007), intraoperative FFP transfusion (p=0.0197), increase in preoperative serum CA19-9 (p=0.0075) and lower postoperative ALC/AMC ratio (p=0.0051) were independent factors for poor disease-free survival. Advanced TNM classification (p=0.0083), lower postoperative ALC/AMC ratio (p=0.0070) and elevated postoperative serum CRP (p=0.0094) were independent factors for poor overall survival.
  
  
  CONCLUSIONS
  Lower postoperative peripheral ALC/AMC ratio may have a negative impact on recurrence and overall survival after pancreatic resection for pancreatic carcinoma.
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan sheetan@jikei.ac.jp.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Fujiwara
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Misawa
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shiba
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Shirai
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Iwase
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Haruki
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Kenei
authors.initials: K
authors.lastname: Furukawa
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Yasuro
authors.initials: Y
authors.lastname: Futagawa
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D011184:Postoperative Period; D011379:Prognosis; D016896:Treatment Outcome
keywords: Lymphocyte-to-monocyte ratio; pancreatic adenocarcinoma; pancreatic resection; prognosis