title: Neutrophil/lymphocyte ratio helps select metastatic pancreatic cancer patients benefitting from oxaliplatin.
abstract: BACKGROUND
  High Neutrophil/Lymphocyte ratio (NLR), as a measure of enhanced inflammatory response, has been negatively associated with prognosis in patients with localized pancreatic ductal adenocarcinoma (PDA).
  
  
  OBJECTIVE
  In the present study, we aimed at investigating the prognostic value of NLR in two homogeneous groups of chemotherapy-naïve metastatic PDA patients. Patients were treated with either gemcitabine (GEM) or gemcitabine/oxaliplatin (GEMOXA). We also assessed whether NLR could identify patients benefiting from the use of oxaliplatin.
  
  
  METHODS
  Consecutive PDA patients treated at the Medical Oncology Unit of Tor Vergata University Hospital of Rome with either GEM or GEMOXA were included (n= 103). NLR was assessed before and during chemotherapy and correlated with outcome together with common clinical and biochemical variables.
  
  
  RESULTS
  Among 17 analyzed variables NLR, Karhofsky Perfomance Status (KPS), d-dimer and erythrocyte sedimentation rate were found to be significantly associated with median Overall Survival (mOS) at the univariate analysis. Only NLR and KPS were independent prognosticator at multivariate analysis, with NLR displaying the highest statistical significance. NLR was also predictive of oxaliplatin activity, as only patients with NLR > 2.5 (cutoff determined upon ROC analysis) derived benefit from GEMOXA over GEM.
  
  
  CONCLUSIONS
  NLR is both an independent prognostic and predictive factor in metastatic PDA, since only patients with high NLR seem to benefit from the addition of oxaliplatin. NLR may help select patients for whom a particularly poor prognosis might justify more intensive, yet less tolerable, combination regimens.
authors.affiliation: Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Formica
authors.affiliation: Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Morelli
authors.affiliation: San Raffaele Roma Open University, Rome, Italy.|Interinstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, Rome, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Ferroni
authors.affiliation: Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Nardecchia
authors.affiliation: Department of Systems Medicine, Internal Medicine, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Manfredi
authors.initials: M
authors.lastname: Tesauro
authors.affiliation: Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Pellicori
authors.affiliation: Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Vittore
authors.initials: V
authors.lastname: Cereda
authors.affiliation: Section of Medical Oncology, Department of Surgical and Oncology Sciences, University of Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Russo
authors.affiliation: Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy.|Interinstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Riondino
authors.affiliation: San Raffaele Roma Open University, Rome, Italy.|Interinstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, Rome, Italy.
authors.forename: Fiorella
authors.initials: F
authors.lastname: Guadagni
authors.affiliation: Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Roselli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015415:Biomarkers; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009504:Neutrophils; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D000077150:Oxaliplatin; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin
keywords: Neutrophil/lymphocyte ratio; gemcitabine; oxaliplatin; pancreatic ductal adenocarcinoma