Inflammatory markers in predicting survival in pancreatic cancer: A Systematic review and Meta-Analysis

Determining an accurate prognosis for pancreatic cancer (PC) can pose significant challenges. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) has been used as prognostic factors to predict outcomes in patients with gastrointestinal cancer. This study aims to reveal the prognostic value of NLR and PLR on survival outcomes and risk of metastasis in PC.

NLR and PLR was investigated for its potential to predict survival outcomes in pancreatic ductal adenocarcinoma (PDAC) and pancreatic neuroendocrine tumor (PNET). For pancreatic cystic neoplasm (PCN), we investigated the potential for inflammatory markers to predict malignancy. Subgroup analysis was performed for tumor resectability, marker cut-off value (COV), and conducted location. Hazard ratios (HRs) and odds ratios (ORs) were pooled and analyzed using a random-effects model.

A total of 105 studies included with a total of 20,138 patients. In PDAC, elevated NLR levels were significantly associated with poorer outcomes of overall survival (OS), progression-free survival (PFS), and recurrence-free survival (RFS) in multivariable analysis (HR 1.79, 1.74, and 1.91, respectively). Similarly, elevated PLR levels in PDAC were also associated with poorer OS and RFS in multivariable analysis (HR 1.33 and 1.94), respectively. For PNET, NLR was significantly associated with OS and RFS in multivariable analysis (HR 2.57 and 3.05, respectively). Furthermore, NLR and PLR show significant association with malignancy in PCN (OR 3.07 and HR 2.42, respectively).

NLR and PLR effectively predicted PC outcomes and hold potential for evaluating therapeutic responses and identifying candidates for additional treatment strategies in advanced disease.