Association of preoperative total lymphocyte count with prognosis in resected left-sided pancreatic cancer.
BACKGROUND
Immunologic factors such as neutrophil-lymphocyte ratio and platelet-lymphocyte ratio play an important role in predicting the oncologic outcome of patients in pancreatic ductal adenocarcinoma (PDAC). It is hypothesized that host immunity represented by total lymphocyte count at diagnostic stage would influence oncologic outcome in left-sided PDAC.


METHODS
Between January 1992 and August 2017, total of 112 patients who underwent distal pancreatectomy for left-sided PDAC were included and analysed.


RESULTS
At the time of the diagnosis, total lymphocyte count at diagnosis of left-sided PDAC was 1.8 ± 0.7 103 /μL (mean value ± standard deviation). Among different cut-off values, 1.7 showed most powerful significant differences in long-term oncologic outcomes. The patients with preoperative lymphocyte count (≤1.7) was associated with early recurrence (median 8.4 months versus 18.1 months, P = 0.011) and shorter survival (median 18.6 months versus 35.9 months, P = 0.028). Patients with preoperative total lymphocyte count over 1.7 showed higher white blood cell count (P < 0.001), platelet count (P = 0.039), neutrophil count (P = 0.004) and monocyte count (P = 0.001). However, more interestingly, neutrophil-lymphocyte ratio (P < 0.001) and platelet-lymphocyte ratio (P < 0.001) were found to be significantly higher in those with total lymphocyte count less than 1.7. Lymphocyte to monocyte ratio was inversely related to preoperative total lymphocyte count (P < 0.001). Only age was identified to be significantly different (P = 0.007). However, other clinicopathological parameters generally known to be related to tumour aggressiveness, were not different between two groups.


CONCLUSION
In conclusion, preoperative total lymphocyte at diagnostic stage is simple, and good prognostic factor in left-sided pancreatic cancer.
['Rho|Seoung Yoon|SY|0000-0002-1265-826X', 'Hwang|Ho Kyoung|HK|', 'Chong|Jae Uk|JU|', 'Yoon|Dong Sup|DS|', 'Lee|Woo Jung|WJ|', 'Kang|Chang Moo|CM|']
D021441:Carcinoma, Pancreatic Ductal D005260:Female D005500:Follow-Up Studies D006801:Humans D007111:Immunity, Cellular D018655:Lymphocyte Count D008214:Lymphocytes D008297:Male D008875:Middle Aged D010180:Pancreatectomy D010190:Pancreatic Neoplasms D057234:Preoperative Period D011379:Prognosis D056910:Republic of Korea D012189:Retrospective Studies D015996:Survival Rate
total lymphocyte count left-sided pancreatic cancer pancreatic cancer neutrophil-lymphocyte ratio platelet-lymphocyte ratio