Inflammatory status as a predictor of resectability in borderline resectable pancreatic cancer

The incidence of pancreatic cancer (PC) has been increasing and continues to be associated with a high mortality rate. Surgical resection is the only curative option. About 15% have borderline resection criteria, where neoadjuvant chemotherapy (NACT) becomes the first approach. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are representative of the systemic inflammatory response. The authors aim to evaluate the impact of these ratios on the resectability of borderline PC.

Retrospective study of patients diagnosed with borderline ressectable PC proposed for NACT from January 2014 to December 2022. NLR and PLR ratio were calculated taking into account the blood count prior to the start of NACT. Their impact on overall survival and resectability rate of the neoplasm was evaluated. The following cut-offs were defined: low NLR 150.

A total of 55 patients were included, 52.7% (n=29) male, with a median age of 63 years [35-80] and 89.1% (n=49) with an ECOG performance status of 0-1. About 81.8% (n=45) were located in the head of the pancreas. Only 9.1% (n=5) were diagnosed in routine exams, the majority were symptomatic with jaundice (65.5%, n=36) and constitutional syndrome (63.6%, n=35). In 54.5% of patients (n=30) NACT was performed with FOLFIRINOX and 40% (n=22) with gemcitabine, of these 18.2% (n=10) underwent subsequent chemoradiotherapy with capecitabine. Thirty-six percent (n=20) underwent exploratory laparotomy and 10 achieved tumor resection. The median follow-up was 11 months [2-74]. About 58.2% (n=32) had a low NLR and 56.4% (n=31) a low PLR. Low NLR and low PLR were shown to have a statistically significant impact on the tumor resectability rate (p=0.034 and p=0.007, respectively), as well as on the overall survival of these patients (low median NLR at 16 months, 95% CI 6.4-25.6 versus high at 11 months, 95% CI 9.5-12.6, p=0.029; median low PLR 17 months, 95% CI 8.9-25.1 versus high 10 month RPL, 95% CI 6.8-13.2, p=0.030). In multivariate analysis, these inflammatory response markers were identified as independent prognostic factors with an impact on OS (NLR: HR 0.49, 95%CI 0.2-0.9, p=0.042; PLR: HR 0.49, 95%CI 0.3-0.9, p=0.040).

The resectability rate and overall survival of borderline PC were shown to be impacted by pretreatment inflammatory response markers NLR and PLR in our investigation. These markers are simple and accessible in our clinical practice, and may help to predict the response to treatments. Prospective studies are imperative to validate key tool in the decision-making of therapeutic strategies in the future.

The authors.

Has not received any funding.

All authors have declared no conflicts of interest.