title: Comprehensive assessment of the prognosis of pancreatic cancer: peripheral blood neutrophil-lymphocyte ratio and immunohistochemical analyses of the tumour site.
abstract: OBJECTIVE
  Several studies have suggested that an elevated neutrophil-lymphocyte ratio (NLR) is associated with a poorer prognosis in patients with pancreatic cancer (PC). The correlations between the NLR and immunohistochemical (IHC) analysis with regard to the prognosis of patients with PC remain to be elucidated. By using IHC findings, we determined the value of the NLR as a prognostic factor in patients with PC.
  
  
  METHODS
  We collected the clinico-pathological data of 28 consecutive patients who underwent surgical resection for PC between January 2008 and December 2012 at The Jikei University Kashiwa Hospital. We investigated whether the NLR and IHC results were related and ensured the consistency of the prognosis of patients with PC.
  
  
  RESULTS
  The Kaplan-Meier curves for the disease-free survival (DFS) and the overall survival (OS) revealed that an NLR ≥ 5 is an implicit factor for decreased DFS and OS in patients with PC (p = 0.003, p < 0.001, log-rank test). The density of CD163(+) macrophages and CD66b(+) neutrophils was significantly higher in the high NLR group; on the contrary, the density of CD20(+) lymphocytes was significantly higher in the low NLR group. Moreover, a Mann-Whitney U test showed that the NLR was significantly correlated with a high density of CD20(+) lymphocytes (p = 0.031) and CD163(+) macrophages (p = 0.023), while the NLR was not significantly correlated with CD66b(+) neutrophils (p = 0.397).
  
  
  CONCLUSIONS
  Our results demonstrated the validity of the NLR by IHC analyses and we determined that a higher value of NLR is a trustworthy prognostic factor for patients with PC.
authors.affiliation: a Division of Gastroenterology and Hepatology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan ;
authors.forename: Kazuki
authors.initials: K
authors.lastname: Takakura
authors.affiliation: a Division of Gastroenterology and Hepatology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan ;
authors.forename: Zensho
authors.initials: Z
authors.lastname: Ito
authors.affiliation: b Department of Public Health and Environmental Medicine , Jikei University School of Medicine , Tokyo , Japan ;
authors.forename: Machi
authors.initials: M
authors.lastname: Suka
authors.affiliation: a Division of Gastroenterology and Hepatology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan ;
authors.forename: Tomoya
authors.initials: T
authors.lastname: Kanai
authors.affiliation: a Division of Gastroenterology and Hepatology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan ;
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: a Division of Gastroenterology and Hepatology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan ;
authors.forename: Shunichi
authors.initials: S
authors.lastname: Odahara
authors.affiliation: a Division of Gastroenterology and Hepatology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan ;
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsudaira
authors.affiliation: c Department of Surgery , Jikei University School of Medicine , Tokyo , Japan ;
authors.forename: Koichiro
authors.initials: K
authors.lastname: Haruki
authors.affiliation: c Department of Surgery , Jikei University School of Medicine , Tokyo , Japan ;
authors.forename: Yuki
authors.initials: Y
authors.lastname: Fujiwara
authors.affiliation: c Department of Surgery , Jikei University School of Medicine , Tokyo , Japan ;
authors.forename: Ryota
authors.initials: R
authors.lastname: Saito
authors.affiliation: c Department of Surgery , Jikei University School of Medicine , Tokyo , Japan ;
authors.forename: Takeshi
authors.initials: T
authors.lastname: Gocho
authors.affiliation: d Department of Oral and Maxillofacial Surgery , Ehime University Graduate School of Medicine , Ehime , Japan ;
authors.forename: Koh-Ichi
authors.initials: K
authors.lastname: Nakashiro
authors.affiliation: d Department of Oral and Maxillofacial Surgery , Ehime University Graduate School of Medicine , Ehime , Japan ;
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hamakawa
authors.affiliation: e Department of Advanced Immunotherapeutics , Kitasato University School of Pharmacy , Tokyo , Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Okamoto
authors.affiliation: a Division of Gastroenterology and Hepatology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan ;
authors.forename: Mikio
authors.initials: M
authors.lastname: Kajihara
authors.affiliation: c Department of Surgery , Jikei University School of Medicine , Tokyo , Japan ;
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Misawa
authors.affiliation: a Division of Gastroenterology and Hepatology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan ;
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Ohkusa
authors.affiliation: a Division of Gastroenterology and Hepatology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan ;
authors.forename: Shigeo
authors.initials: S
authors.lastname: Koido
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007564:Japan / Q000453:epidemiology; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D009504:Neutrophils / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D047368:Tumor Burden
keywords: Immunohistochemistry; neutrophil–lymphocyte ratio; pancreatic cancer; prognosis