Baseline neutrophil-to-lymphocyte ratio (NLR) at the time of diagnosis of liver metastasis is an independent prognostic factor for patients with pancreatic cancer liver metastasis (PCLM)

Background Pancreatic cancer with liver metastasis (PCLM) has a very poor chance of long-term survival. There is a lack of effective prognostic markers that reflect the tumor microenvironment in those patients. Objective This study was performed to determine the prognostic role of systemic immune-inflammation index neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) in PCLM. Methods A retrospective analysis was performed in cases of PCLM at our institution between November 2011 and November 2022. NLR, PLR, and LMR values were available and analyzed with respect to survival outcomes. Log-rank and Cox proportional hazards models were used to evaluate the associations between baseline NLR, PLR, LMR at the time of diagnosis of liver metastasis, and progressive free survival (PFS) and overall survival (OS). Results A total of 108 patients with PCLM were included of whom the optimal prognostic OS cutpoint for NLR, PLR, and LMR were 3.5, 3.4, and 172.5, respectively. OS (p < 0.0001) and PFS (p < 0.0001) was significantly decreased in PCLM with high NLR compared to low NLR groups. Similarly, OS (p = 0.03) and PFS (p = 0.02) shortened in high PLR groups. In univariate analysis of variables, NLR (HR = 2.24 [1.45, 3.45], P = 0.000) and CA199 levels (HR = 1.73 [1.11, 2.69], P = 0.015) were found to have a significant correlation with OS, and NLR (HR = 2.28 [1.5, 3.46], P = 0.000) and PLR (HR = 1.63 [1.06, 2.5], P = 0.026) were found to be significantly relevant for PFS. On multivariate analysis, NLR (HR = 2.38 [1.41, 4.04], P = 0.001) and CA199 (HR = 2.09 [1.27, 3.44], P = 0.004) were found to be as independent prognostic factors for OS, only NLR (HR = 2.08 [1.29, 3.34], P = 0.002) was found to be as an independent prognostic factor for PFS. Conclusion Baseline NLR at the time of diagnosis of liver metastasis is an independent prognostic value for PCLM. NLR may serve as a good potential biomarker of prognosis for these patients in clinic.