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Identifying the role of neutrophil-to-lymphocyte ratio and 
platelets-to-lymphocyte ratio as prognostic markers in patients 
undergoing resection of pancreatic ductal adenocarcinoma 

Ann Hepatobiliary Pancreat Surg 2018 Aug;22(3):197-207
Published online August 31, 2018
Copyright © 2018 Ann Hepatobiliary Pancreat Surg.

Alexandros Giakoustidis1, Kyriakos Neofytou1, Mafalda Costa Neves1, Dimitrios Giakoustidis1,2, Eleni Louri3, David Cunningham4, Satvinder Mudan1,5,6

1Department of Academic Surgery, The Royal Marsden Hospital, London, UK,
2Department of Surgery & Transplantation, Aristotle University of Thessaloniki, Thessaloniki, Greece,
3Department of Gynaecology-Oncology, The Royal London Hospital, 
4Department of Gastrointestinal Oncology,The Royal Marsden Hospital, 
5Department of Surgery and Cancer, Faculty of Medicine, Imperial College,
6Department of Gynaecology-Oncology, The London Clinic, London, UK
Received January 13, 2018; Revised February 13, 2018; Accepted February 16, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: It is important to point out that the identification of inflammation is an essential component of the pathogenesis and the progression of cancer. In this study, we analysed the neutrophil-to-lymphocyte ratio (NLR) and the platelets-to-lymphocyte ratio (PLR), with an overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC), who were treated with a resection following or not following a procedure of neoadjuvant chemotherapy/chemoradiation. We intended to identify the significance of the role of NLR and PLR, as prognostic markers in patients undergoing surgery for PDAC. 
Methods: There were 127 patients enrolled in the study. The NLR and PLR were calculated on the basis of the pre-treatment blood cell count. An NLR>4 and a PLR >120 were considered to be elevated as measured. OS was analysed in relation to the NLR and PLR values, by using both the Kaplan-Meier and multivariate Cox-regression methods. 
Results: Both high the NLR and high PLR were associated with a decreased OS in the univariate analysis. In the multivariate analysis, the high NLR, but not the high PLR, was an independent predictor of a decreased OS. When we divided patients into three groups (group 1: normal both NLR and PLR, group 2: high NLR or high PLR, group 3: high both NLR and PLR), the three-years OS rates for these groups were 48%, 32%, 7% (p=0.001) respectively. 
Conclusions: It is noted that the pre-treatment NLR is an independent adverse prognostic factor, and considered to be superior to the PLR, in patients who undergo a resection for PDAC following or not neoadjuvant chemotherapy/chemoradiation.
Keywords : Pancreatic ductal adenocarcinoma; Inflammation; NLR; PLR; Prognostic factor


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