title: Preoperative Neutrophil-Lymphocyte and Lymphocyte-Monocyte Ratios Reflect Immune Cell Population Rearrangement in Resectable Pancreatic Cancer.
abstract: BACKGROUND
  Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) may serve as a simple index of the immune function. The aim of this study was to investigate the prognostic significance of NLR, PLR, and LMR in patients with resectable pancreatic ductal adenocarcinoma (PDAC) and to verify whether such biomarkers are associated with changes in populations of lymphoid cells.
  
  
  METHODS
  The prognostic implications of blood count parameters were evaluated in a retrospective cohort of 442 subjects undergoing pancreatic resections for PDAC. Subpopulations of lymphocytes and monocytes in peripheral blood were identified by FACS in a prospective cohort of 54 patients.
  
  
  RESULTS
  In the univariate analysis, NLR < 5 and LMR ≥ 3 were associated with significantly longer median survival of 25.7 vs 12.6 months and 29.2 vs 13.1 months, respectively. PLR did not influence survival. The Cox proportional hazards model showed that high NLR (HR 1.66, 95 % CI 1.12 to 2.46, P = 0.012) and low LMR (HR 1.65, 95 % CI 1.06 to 2.58, P = 0.026) were independent predictors of poor prognosis. NLR ≥ 5 and LMR < 3 correlated with an approximately twofold decrease in counts of helper and cytotoxic T cells, B cells, and NK cells. High NLR was also accompanied with increased neutrophil counts, while low LMR showed increased numbers of monocytes, mostly classical.
  
  
  CONCLUSIONS
  NLR and LMR may carry important prognostic information for patients with resected PDAC. The unfavorable prognosis likely correlates with reduced numbers of immune cells effective against the tumor and increased populations of cells involved in immune suppression.
authors: First Department of General and GI Surgery, Jagiellonian University Medical College, Krakow, Poland. marek.sierzega@uj.edu.pl.
authors: Marek
authors: M
authors: Sierzega
authors: Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
authors: Marzena
authors: M
authors: Lenart
authors: Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
authors: Magdalena
authors: M
authors: Rutkowska
authors: Laboratory of Clinical Immunology, University Children's Hospital, Krakow, Poland.
authors: Marta
authors: M
authors: Surman
authors: Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
authors: Bozenna
authors: B
authors: Mytar
authors: First Department of General and GI Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors: Andrzej
authors: A
authors: Matyja
authors: Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
authors: Maciej
authors: M
authors: Siedlar
authors: First Department of General and GI Surgery, Jagiellonian University Medical College, Krakow, Poland.
authors: Jan
authors: J
authors: Kulig
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001402:B-Lymphocytes; D014408:Biomarkers, Tumor / Q000097:blood; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood* / Q000276:immunology / Q000601:surgery; D005260:Female; D006801:Humans; D007694:Killer Cells, Natural; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D009504:Neutrophils; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000276:immunology / Q000601:surgery; D010976:Platelet Count; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D013602:T-Lymphocytes, Cytotoxic; D006377:T-Lymphocytes, Helper-Inducer; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor