Prognostic value of the early change in neutrophil-to-lymphocyte ratio in metastatic pancreatic adenocarcinoma

In metastatic pancreatic adenocarcinoma, a high neutrophil-to-lymphocyte ratio (NLR) at diagnosis is a marker of poor prognosis. The prognostic role of baseline NLR and NLR change during first-line chemotherapy were determined. We conducted a retrospective study by using data from a single-center prospective cohort and a randomized open-label, multicenter, randomized trial. Two hundred and twelve patients were analyzed. Baseline NLR > 5 was an independent marker of poor prognosis for overall survival (HR = 2.01, 95% CI 1.33−3.05; P = 0.001) and progression-free survival (PFS; HR=1.80, 95% CI 1.23–2.65; P = 0.0026). According to NLR dynamics (n = 172), patients with NLR ≤ 5 on days 1 and 15 had a significantly better prognosis than those with NLR ≤ 5 on day 1 and NLR > 5 on day 15 (HR = 2.23, 95% CI 1.18–4.21; P = 0.013), NLR >5 on day 1 and NLR ≤5 on day 15 (HR=3.25, 95% CI 1.86–5.68; P < 0.001), and NLR>5 on days 1 and 15 (HR=3.37, 95% CI 1.93–5.90; P < 0.001). Over time, bad responders (PFS <6 months) had significantly higher mean NLR than good responders (PFS>6 months; group effect: P < 0.0001). Seven out of eight patients with baseline NLR>5 had circulating tumor DNA. This study confirmed the independent prognostic value of baseline NLR >5 in metastatic pancreatic cancer. The change in NLR early during chemotherapy was also a prognostic indicator in patients with NLR ≤5.