In metastatic pancreatic adenocarcinoma, a high neutrophil-to-lymphocyte ratio (NLR) at diagnosis is a marker of poor prognosis. The prognostic role of baseline NLR and NLR change during first-line chemotherapy were determined. We conducted a retrospective study by using data from a single-center prospective cohort and a randomized open-label, multicenter, randomized trial. Two hundred and twelve patients were analyzed. Baseline NLR>5 was an independent marker of poor prognosis for overall survival (HR = 2.01, 95 CI 1.33-3.05; P = 0.001) and progression-free survival (PFS; HR=1.80, 95 CI 1.23-2.65; P = 0.0026). According to NLR dynamics (n= 172), patients with NLR 5 on day 15 (HR = 2.23, 95 CI 1.18-4.21; P = 0.013), NLR >5 on day 1 and NLR 5 on days 1 and 15 (HR=3.37, 95 CI 1.93-5.90; P6 months; group effect: P5 had circulating tumor DNA. This study confirmed the independent prognostic value of baseline NLR >5 in metastatic pancreatic cancer. The change in NLR early during chemotherapy was also a prognostic indicator in patients with NLR <5.
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