Elevated pre-operative neutrophil to lymphocyte ratio predicts disease free survival following pancreatic resection for periampullary carcinomas

Background: The pre-operative neutrophil-to-lymphocyte ratio (NLR), when >= 5 has been associated with reduced survival for patients with various gastrointestinal tract cancers, however, it's prognostic value in patients with periampullary tumour has not been reported to date. Objectives: To determine the prognostic value of pre-operative NLR in terms of survival and recurrence of resected periampullary carcinomas. Methods: This was a retrospective cohort study of consecutive patients undergoing pancreatoduodenectomy (PD) for periampullary carcinoma (pancreatic, ampullary, cholangiocarcinoma) identified from a departmental database. The effect of NLR upon survival and recurrence was explored. Results: Overall median survival amongst 228 patients was 24 months (inter-quartile range [IQR]: 12-43). The median survival for those whose NLR was <5 was not significantly greater than those patients whose NLR was >= 5 (24 months [IQR: 14-42] versus 13 months [IQR: 8-48], respectively; p=0.234). However, for those that developed recurrence, survival was greater in those with an NLR <5 at (20 months [IQR: 12-27] versus 11 months [IQR: 7-22], respectively; p=0.038). This effect was most marked in those patients with cholangiocarcinoma (p=0.019) whilst a trend to worse Survival was seen in those with pancreatic adenocarcinoma. No effect was seen in patients with ampullary carcinoma (p=0.516). Conclusions: This study provides further evidence that pre-operative NLR offers important prognostic information regarding disease-free survival. This effect, however, is dependent upon the tumour type amongst patients undergoing PD. Copyright (C) 2013, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.