title: Prognostic impact of preoperative NLR and CA19-9 in pancreatic cancer.
abstract: BACKGROUND
  Recently, several preoperative proinflammatory markers and nutritional factors such as neutrophil-to-lymphocyte ratio (NLR) and prognostic nutrition index (PNI) have been reported as significant predictor for poor prognosis of various malignant tumors. In this study, we evaluated the prognostic values of these preoperative parameters in patients with resectable pancreatic head cancer.
  
  
  METHODS
  We retrospectively reviewed consecutive patients who underwent PD for pancreatic head cancer between 2007 and 2012. A total of 46 patients were enrolled in this analysis. Preoperative parameters such as CRP, CA19-9, NLR and PNI at the time of presentation were recorded as well as overall survival. Cancer specific survival was assessed using Kaplan-Meier method. Univariate and multivariate Cox regression models were applied to evaluate the prognostic relevance of preoperative parameters. The correlations between CA19-9 values, NLR and pathological findings, first recurrence site were respectively reviewed.
  
  
  RESULTS
  In multivariable analysis preoperative high NLR (≧2.7) and high CA19-9 (≧230) were independent prognostic factors for poor survival (P value: 0.03 and 0.025, respectively). Kaplan-Meier survival analysis demonstrated the overall 2-year survival rate in patients with high NLR or high CA19-9 were 37.5% compared with 89.9% in patients with low NLR and low CA19-9.
  
  
  CONCLUSIONS
  Preoperative NLR and serum CA19-9 offer significant prognostic information associated with overall survival following PD in the patients with pancreatic head cancer.
authors: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan; Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. Electronic address: tasaoka@gesurg.medosaka-u.ac.jp.
authors: Tadafumi
authors: T
authors: Asaoka
authors: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
authors: Atsushi
authors: A
authors: Miyamoto
authors: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
authors: Sakae
authors: S
authors: Maeda
authors: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
authors: Masanori
authors: M
authors: Tsujie
authors: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
authors: Naoki
authors: N
authors: Hama
authors: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
authors: Kazuyoshi
authors: K
authors: Yamamoto
authors: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
authors: Masakazu
authors: M
authors: Miyake
authors: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
authors: Naotsugu
authors: N
authors: Haraguchi
authors: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
authors: Kazuhiro
authors: K
authors: Nishikawa
authors: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
authors: Motohiro
authors: M
authors: Hirao
authors: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
authors: Masataka
authors: M
authors: Ikeda
authors: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
authors: Mitsugu
authors: M
authors: Sekimoto
authors: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
authors: Shoji
authors: S
authors: Nakamori
mesh_terms: D000368:Aged; D018395:CA-19-9 Antigen / Q000097:blood*; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011237:Predictive Value of Tests; D011300:Preoperative Care; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D018395:CA-19-9 Antigen
keywords: CA19-9; Neoadjuvant chemotherapy; Neutrophil-to-lymphocyte ratio (NLR); Pancreatic cancer; Pancreatic head cancer; Pancreatoduodenectomy