The combination of systemic inflammation-based marker NLR and circulating regulatory T cells predicts the prognosis of resectable pancreatic cancer patients

BackgroundThe systemic inflammation response and immune impairment are closely related to the development and progression of various tumours, such as pancreatic cancer. In this study, we evaluated circulating inflammation factors and circulating regulatory T cells (Tregs) as markers of immunosuppression in a cohort of Chinese patients with resectable pancreatic cancer.MethodsSamples were retrospectively collected from a series of 195 pathological stage I/II pancreatic cancer patients who underwent potentially curative surgery between June 2010 and April 2014. To examine the prognostic factors, circulating systemic inflammation-based markers and Tregs, detected by flow cytometry, were analysed.ResultsUnivariate analyses revealed that the neutrophil-lymphocyte ratio (NLR), TNM stage, differentiation, chemotherapy, CA19-9 levels and presence of Tregs are significantly associated with overall survival in patients with resectable pancreatic cancers. NLR (p = 0.001, HR = 0.538), TNM stage (p = 0.004, HR = 0.593), differentiation (p = 0.011, HR = 0.46), chemotherapy (p = 0.006, HR = 0.516) and Tregs (p = 0.001, HR = 0.558) are identified as independent prognostic markers by multivariate analyses. Interestingly, we also found that high NLR levels combined with a high proportion of Tregs (p < 0.001, HR = 3.521) correlate strongly with worse survival, with a greater than 3.5–fold increased risk of death compared with those with concurrent low levels of NLR and Tregs.ConclusionsThe preoperative NLR and circulating regulatory T cells are potentially independent prognostic factors for overall survival in resectable pancreatic cancer patients. High NLR levels combined with poor immune state before surgery, as measured by Tregs, are associated with an extremely poor prognosis.