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Received Feb 26, 2018; Revised May 7, 2018; Accepted May 21, 2018
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Background
Pancreatic cancer is the ninth most common cancer and the forth cause of cancer-related mortality worldwide. Five-year overall survival (OS) does not exceed 5% due to the fact that more than 85% of patients are diagnosed with incurable locally advanced or metastatic disease [1, 2]. FOLFIRINOX (oxaliplatin, irinotecan, fluorouracil, and leucovorin) or gemcitabine plus albumin-bound paclitaxel is the current standard of care in the first-line setting for patients with metastatic disease [3, 4]. Despite these newer regimens have increased survival, it remains extremely poor still today. Therefore, it is important to clarify the biological mechanisms that contribute to tumor progression as well as to identify prognostic factors for stratify individual risk. During last years, tumor size, histologic grade, vascular invasion, perineural invasion, lymph node metastases, and distant metastases have been recognized as prognostic factors [5–7]. Recently, growing interest in the role of inflammatory response has emerged. Tumor microenvironment is known to have an important role in cancer development and progression and may be associated with systemic inflammation that could be a significant predictor of survival. Hypoalbuminemia, elevated C-reactive protein, increased levels of cytokines, and high leukocyte count and their subtypes are measurable parameters in blood that reflect the systemic inflammatory response [8–13]. Actually, several evidences suggesting that an elevated peripheral blood neutrophil to lymphocyte ratio (NLR) is related to a worse outcome in various types of cancer, including renal cell carcinoma, soft tissue sarcoma, nonsmall cell lung cancer (NSCLC), breast cancer, and colorectal cancer (CRC) [14–22]. We analyzed retrospectively the prognostic independent role of pretreatment NLR in a cohort of 70 metastatic pancreatic patients treated with gemcitabine plus nab-paclitaxel as first-line chemotherapy enrolled in two different European oncologic centers. In this study, we showed that NLR is an independent predictor of the prognosis for metastatic pancreatic cancer patients and that high NLR levels are associated with a short life expectancy.
2. Patients and Methods
70 patients were diagnosed with metastatic pancreatic cancer in the Department of Oncology at the Second University...