Clinical implications of systemic inflammatory response markers as independent prognostic factors for advanced pancreatic cancer

Background: Cancer-associated inflammation is a key molecular feature of pancreatic ductal adenocarcinoma. In this study, we systematically evaluated the prognostic relevance of systemic inflammatory response (SIR) markers in patients with advanced pancreatic cancer.

Methods: A total of 321 consecutive patients with pathologically-confirmed locally advanced or metastatic pancreatic adenocarcinoma were retrospectively recruited. The patients were divided into a test set (n = 110) and a validation set (n = 211). The associations between overall survival (OS) and clinically available SIR markers including white blood cell (WBC) count, absolute neutrophil count, absolute lymphocyte count, absolute monocyte count, platelet count, neutrophil-lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and lymphocyte/monocyte ratio (LMR) were analyzed using Kaplan-Meier curves and multivariate Cox proportional models.

Results: High WBC count, neutrophil count, monocyte count, NLR, PLR and low LMR were significantly associated with decreased OS in the test set. Using the validation set for confirmation, we found also in multivariate analysis an independent value of WBC count (hazard ratio (HR): 2.176, 95% confidence interval (CI): 1.560-3.035, P < 0.001), neutrophil count (HR: 2.807, 95% CI: 2.000-3.940, P < 0.001), monocyte count (HR: 1.848, 95% CI: 1.315-2.598, P < 0.001), NLR (HR: 2.204, 95% CI: 1.590-3.055, P < 0.001), PLR (HR: 1.537, 95% CI: 1.114-2.122, P = 0.009) and LMR (HR: 0.569, 95% CI: 0.412-0.784, P = 0.001) for OS in patients with advanced pancreatic cancer.

Conclusions: Our study confirmed that SIR markers can be used to determine optimal therapeutic strategies for individual patients and to predict pancreatic cancer prognosis.