Research Papers:

Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and their dynamic changes during chemotherapy is useful to predict a more accurate prognosis of advanced biliary tract cancer

Kyoung-Min Cho, Hyunkyung Park, Do-Youn Oh _, Tae-Yong Kim, Kyung-Hun Lee, Sae-Won Han, Seock-Ah Im, Tae-You Kim and Yung-Jue Bang

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Oncotarget. 2017; 8:2329-2341. https://doi.org/10.18632/oncotarget.13731

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Kyoung-Min Cho1,3, Hyunkyung Park1, Do-Youn Oh1,2, Tae-Yong Kim1, Kyung-Hun Lee1,2, Sae-Won Han1,2, Seock-Ah Im1,2, Tae-You Kim1,2 and Yung-Jue Bang1,2

1 Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

2 Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

3 Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea

Correspondence to:

Do-Youn Oh, email:

Keywords: inflammation, prognosis, advanced biliary tract cancer, neutrophil-to-lymphocyte ratio

Received: September 06, 2016 Accepted: November 24, 2016 Published: November 30, 2016


Background and Purpose: Systemic inflammation is known to promote carcinogenesis in biliary tract cancer (BTC). Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are indicative of systemic inflammation. We evaluated the clinical significance of systemic inflammation measured by NLR and PLR in patients with advanced BTC. Additionally, we also co-analyzed the dynamics of NLR and PLR during chemotherapy.

Methods: We reviewed 450 patients with unresectable BTC receiving palliative chemotherapy. NLR and PLR were obtained before initiation of palliative chemotherapy. Changes in NLR, PLR were obtained by subtracting the initial value from the value obtained after progression of chemotherapy.

Results: Higher systemic inflammation status also had relation with a primary tumor site (p = 0.003) and higher levels of CEA (p = 0.038). The ROC cut-off values of NLR and PLR for predicting overall survival (OS) were 3.8 and 121, respectively. Patients with a high NLR or PLR had worse OS independently in multivariate analysis (6.90 vs. 9.80 months, p =0.002; 7.83 vs. 9.90 months, p =0.041, respectively). High NLR with increased NLR after chemotherapy is associated with worse OS and progression-free survival (PFS) (p < 0.001, p = 0.013 respectively). Results are similar for PLR.

Conclusion: Systemic inflammation represented by NLR and PLR, predicts the OS of patients with advanced BTC who are receiving palliative chemotherapy. In addition, considering NLR/PLR with a dynamic change of NLR/PLR during chemotherapy might help to predict a more accurate prognosis.

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