A37: The Prechemotherapy Neutrophil-to-Lymphocyte ratio predicts survival in locally advanced/metastatic pancreatic carcinoma
1Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
The neutrophil- to - lymphocyte ratio (NLR) is a prognostic factor independent of stage or performance status for many malignancies. The role in the prediction of survival in pancreatic cancer patients receiving systemic therapy remains unclear. This study investigated the relationship between the pre-chemotherapy NLR and survival in patients with advanced pancreatic carcinoma at Gloucestershire Hospitals NHS Foundation Trust.
The medical records of all patients who received palliative chemotherapy for pancreatic carcinoma from July 2012 to June 2014 were reviewed and the pre-chemotherapy NLR calculated (absolute neutrophil count divided by lymphocyte count). Patients with active infection/continued biliary obstruction were excluded. Follow up data to March 2015 was available.
84 patients of performance status 0-2 received gemcitabine based chemotherapy. 6 patients were excluded due to lack of immediate pre-chemotherapy NLR being available. 59 /72 patients received gemcitabine (GEM), 12/72 gemcitabine and capecitabine (GCAP), 3/72 GEM followed by GCAP on progression, 2 /72 GEM followed by oxaliplatin and capecitabine (XELOX) , 1 /72 (GEM+XELOX+GEM) and 1 /72 GCAP followed by FOLFIRINOX (5FU/Leucovorin+Irinotecan+Oxaliplatin).
At data censor in March 2015, 72 patients (92%) had died with a median survival of 6.1 months. The median NLR was 4.4 (range 1.3-26.6). 46 patients (59%) had a prechemotherapy NLR <5 and had a median survival of 8.7 months (Range 1.2-24.8). 32 patients (41%) had a prechemotherapy NLR >5 with a median survival of 2.2 months (Range 0.1-21.2).
Patients with locally advanced and metastatic pancreatic carcinoma patients in whom NLR is <5 before chemotherapy have longer median overall survival compared to patients whose NLR is >5. A simple blood test with calculation of the NLR prior to initiating systemic therapy can offer further information on prognosis and therefore aid discussions with patients into the value of palliative chemotherapy.