External validation of the derived neutrophil to lymphocyte ratio as a prognostic marker on a large cohort of pancreatic cancer patients

PLoS One. 2013 Nov 4;8(11):e78225. doi: 10.1371/journal.pone.0078225. eCollection 2013.


Background: With growing evidence on the role of inflammation in cancer biology, the presence of a systemic inflammatory response has been postulated as having prognostic significance in a wide range of cancer types. The derived neutrophil to lymphocyte ratio (dNLR), which represents an easily determinable potential prognostic marker in daily practise and clinical trials, has never been externally validated in pancreatic cancer (PC) patients.

Methods: Data from 474 consecutive PC patients, treated between 2004 and 2012 at a single centre, were evaluated retrospectively. Cancer-specific survival (CSS) was assessed using the Kaplan-Meier method. To evaluate the prognostic relevance of dNLR, univariate and multivariate Cox regression models were applied.

Results: We calculated by ROC analysis a cut-off value of 2.3 for the dNLR to be ideal to discriminate between patients' survival in the whole cohort. Kaplan-Meier curve reveals a dNLR≥2.3 as a factor for decreased CSS in PC patients (p<0.001, log-rank test). An independent significant association between high dNLR≥2.3 and poor clinical outcome in multivariate analysis (HR = 1.24, CI95% = 1.01-1.51, p = 0.041) was identified.

Conclusion: In the present study we confirmed elevated pre-treatment dNLR as an independent prognostic factor for clinical outcome in PC patients. Our data encourage independent replication in other series and settings of this easily available parameter as well as stratified analysis according to tumor resectability.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / analysis
  • Female
  • Humans
  • Inflammation / diagnosis
  • Inflammation / immunology
  • Inflammation / mortality
  • Inflammation / pathology
  • Kaplan-Meier Estimate
  • Leukocyte Count
  • Lymphocytes / immunology
  • Lymphocytes / pathology*
  • Male
  • Middle Aged
  • Neutrophils / immunology
  • Neutrophils / pathology*
  • Pancreatic Neoplasms / diagnosis
  • Pancreatic Neoplasms / immunology
  • Pancreatic Neoplasms / mortality
  • Pancreatic Neoplasms / pathology*
  • Prognosis
  • Proportional Hazards Models
  • ROC Curve
  • Retrospective Studies


  • Biomarkers

Supplementary concepts

  • Pancreatic Carcinoma