Does Preoperative Serum Neutrophil To Lymphocyte Ratio (NLR), Platelet To Lymphocyte Ratio (PLR) And Lymphocyte To Monocyte Ratio (LMR) Predict Prognosis Following Radical Surgery For Pancreatic Adenocarcinomas? - Results of A Retrospective Study

Background:Pretherapy serum neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) have been shown to predict prognosis in patients with pancreatic ductal adenocarcinoma (PDAC). However, the published literature is conflicting, hence we aimed to evaluate their role in predicting survival outcomes in operated patients of PDAC.Methods: A retrospective analysis was done of all operated cases of PDAC who underwent curative resection between 2011 to 2018. The pretherapy NLR, PLR and LMR were calculated and analyzed with respect to pathological and survival outcomes Results:134 operated patients were included. The median overall survival for NLR of less than 2, 2.7 and 5 was 30.8, 27.2 and 27.5 months and for NLR more than 2, 2.7 and 5 was 22.9, 21.6 and 21.5 months respectively and was statistically insignificant (p-value- 0.32, 0.91, 0.34 respectively). Similarly, the PLR was not significant for a cut off of 150 (p-value- 0.27) and LMR was not significant for a cut off of 2.8 (p-value- 0.13) and 4.8( p-value -0.11). On Univariate analysis age, CA 19-9, perineural invasion, margin positivity, lymph node positivity and TNM stage were found to have significant correlation with overall survival. However, on multivariate analysis, only TNM stage was found to be significant. Conclusion:The NLR, PLR and LMR do not correlate with overall survival in operated patients with PDAC in this study. A combination of inflammatory markers or their dynamic testing might probably achieve prognostic significance.