Sorbonne Université, 4 Place Jussieu, 75005, Paris, France; Department of Hepato-Gastroenterology, Hôpital Pitié-Salpêtrière, 47 Boulevard de l'Hôpital 75013, APHP, Paris, France.
Department of Methodology and Quality of Life Oncology, University Hospital, 3 Boulevard Alexandre Fleming, 25000 Besancon, France; Bourgogne Franche-Comté Université, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, 8 rue du Docteur Jean-François-Xavier Girod, 25020 Besançon, France.
Clin Res Hepatol Gastroenterol. 2021 May;45(3):101541. doi: 10.1016/j.clinre.2020.08.016. Epub 2020 Oct 11.
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.
在转移性胰腺腺癌中，诊断时高中性粒细胞与淋巴细胞比值（NLR）是预后不良的标志物。本研究旨在确定基线 NLR 和一线化疗期间 NLR 变化的预后作用。我们通过使用单中心前瞻性队列和随机开放标签、多中心、随机试验的数据进行了回顾性研究。共分析了 212 例患者。基线 NLR＞5 是总生存期（HR=2.01，95%CI 1.33-3.05；P=0.001）和无进展生存期（PFS；HR=1.80，95%CI 1.23-2.65；P=0.0026）的独立预后标志物。根据 NLR 动态变化（n=172），第 1 天和第 15 天 NLR≤5 的患者的预后明显优于第 1 天 NLR≤5 而第 15 天 NLR＞5（HR=2.23，95%CI 1.18-4.21；P=0.013）、第 1 天 NLR＞5 而第 15 天 NLR≤5（HR=3.25，95%CI 1.86-5.68；P＜0.001）以及第 1 天和第 15 天 NLR＞5（HR=3.37，95%CI 1.93-5.90；P＜0.001）的患者。随着时间的推移，无进展生存期（PFS）＜6 个月的不良反应者的平均 NLR 显著高于 PFS＞6 个月的良好反应者（组间差异：P＜0.0001）。基线 NLR＞5 的 8 例患者中有 7 例存在循环肿瘤 DNA。本研究证实了转移性胰腺腺癌中基线 NLR＞5 的独立预后价值。化疗早期 NLR 的变化也是 NLR≤5 患者的预后指标。
