Pretreatment Platelet-lymphocyte Ratio Is An Independent Significant Prognostic Marker In Advanced Pancreatic Cancer Patients Undergoing Gemcitabine-based Chemotherapy

Purpose:There is increasing evidences showing that the inflammatory cells in the tumormicroenvironment significantly contribute to the development and progression of cancers.Recently,serological pro-inflammatory markers have been investigated as potential prognostic factors for many cancers,including neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),lymphocyte-to-monocyte ratio(LMR)and prognostic nutritional index(PNI).The purpose of this study was toexplorewhether pretreatment inflammatory markers were associated with survivalinadvanced pancreatic cancer patients treated with gemcitabine(GEM)-based chemotherapy in Chinese population.Methods:53 patientswithadvanced pancreatic cancerat the Qilu Hospital of Shandong University were enrolled in this study from 1 January 2008 to 31 June 2015.All the patients were initially diagnosed with pancreatic carcinoma instage IV.Among them,12 patients underwent treatment of GEM alone,26 patients underwent treatment of GEM combining fluorouraciland 15 patients were treated with GEMcombined withplatinum.Laboratory values were collected before chemotherapy.Neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),lymphocyte-to-monocyte ratio(LMR)and prognostic nutritional index(PNI)were calculated,and their cut-off values were determined by receiver operating characteristic(ROC)curve analysis.Kaplan-Meier survival analysisand Cox proportional hazards model were performed to determine effects of probable prognostic factors.Results:Compared with NLR<3.675,patients in NLR?3.675 had significantly poorer overall survival(250 days vs.192 days,P=0.044,HR=0.500).Median survival were also significantly different between PLR<176.62 and PLR? 176.62(213 days vs.168 days,P=0.010,HR=0.434).While no significant difference in overall survival rates were observed between LMR<2.815 group and LMR?2.815 group(189 days vs.201 days,P=0.350,HR=1.362),as well as between PNI<42.11 group and PNI?42.11 group(180 days vs.201 days,P=0.250,HR=1.457).Elevated PLR was more likely to related to ever smoked(P<0.05),but not with gender,age,alcohol-preferring behavior,diabetes mellitus,coronary disease,CEA,CA19-9,albumin.NLR>3.675 was also associated withever smoked(P<0.05),but not with gender,age,alcohol-preferring behavior,diabetes mellitus,coronary disease,CEA,CA19-9,albumin.Univariate analysis revealedthat NLR>3.675 and PLR?176.62 were significantly associated with poorer overall survival.While in multivariate analysis,PLR>176.62(P=0.001,HR=0.107[95%CI,0.028-0.413])but not NLR>3.675 remainedsignificantly correlated with shorter survival.Patientswith PLR>176.62 had significantly poorer survival(168 days)compared to patients with PLR<176.62(213 days,P=0.024).However,there were no significant differences in survival between LMR<2.815 group and LMR?2.815 group(P=0.350),as well as between PNI<42.11 group and PNI>42.11 group(P=0.250).Conclusion:PLR can be an independentindicatorfor patients with pancreatic cancer undergoing GEM-based chemotherapy in Chinese population.Patients with higher PLR would have worse survival outcomes after GEM-based chemotherapy.NLR,MLR,PNI didnot have independent prognostic values in these cases.