Platelet to lymphocyte ratio in biliary tract cancer: Review and meta-analysis

Model for end-stage liver disease-dependent prognostic capacity of platelet-to-lymphocyte ratio following liver transplantation for hepatocellular carcinoma

BACKGROUND

To improve liver organ allocation, the model for end-stage liver disease (MELD) score was adopted in candidates reflecting the severity of liver disease and the physical condition of patients. Inflammatory markers are prognostic factors for various cancers and play prognostic roles in patients after liver transplantation (LT) for hepatocellular carcinoma (HCC). Researchers focused more on pre-LT inflammatory markers, while the role of dynamic change of these inflammatory markers is still unknown. The purpose of this study was to estimate the prognostic value of pre-LT and post-LT inflammatory markers.

MATERIAL AND METHODS

We collected the pre-LT complete blood count and the post-LT result with highest count of white blood cells within 48 h. Platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio and systemic immune-inflammation index were calculated, and their prognostic roles were analyzed for their MELD scores.

RESULTS

This retrospective two-center cohort study enrolled 290 patients after LT for HCC. Multivariate analysis identified pre-LT PLR as independent risk factor for recurrence-free survival (RFS) [HR (95%CI): 1.002 (1.000-1.003), p = 0.023]. A high pre-LT PLR or post-LT PLR were associated with poorer RFS (p < 0.001 and p = 0.004, respectively). Based on the MELD scores, the pre-LT PLR value was able to predict the RFS in high MELD group (p < 0.001) but had no predictive power in low MELD group (p = 0.076). On the contrary, the post-LT PLR value was better to predict the overall RFS value in low MELD group (p = 0.007) but could not predict the overall RFS value in high MELD group (p = 0.136).

CONCLUSIONS

Both pre-LT PLR and post-LT PLR demonstrated prognostic value in patients following LT for HCC. Monitoring PLR values based on the MELD score can improve the predictive prognosis and more effectively guide the individual decisions for the postoperative intervention.

The predictive role of the platelet-to-lymphocyte ratio for the risk of non-alcoholic fatty liver disease and cirrhosis: a nationwide cross-sectional study

Background

The associations between platelet-to-lymphocyte ratio (PLR) and non-alcoholic fatty liver disease (NAFLD) and cirrhosis are unclear, and there are still no effective means for diagnosing or monitoring disease progression.

Methods

Data from the National Health and Nutrition Examination Surveys were collected for analysis. Logistic regression and restricted cubic splines were used to evaluate the associations between PLR and NAFLD and cirrhosis in different populations. The Area Under Curve Receiver Operating Characteristic (AUCROC) was used to distinguish the models. Threshold analysis was performed by constructing a two-piecewise linear regression. Correlation analysis was performed separately on either side of the inflection point.

Results

A total of 5724 adults were included. Logistic regression analysis revealed that the PLR was associated with NAFLD and cirrhosis (AUCROC of NAFLD: 0.803; AUCROC of cirrhosis: 0.851). The AUCROC of the PLR for predicting NAFLD incidence was 0.762 in the diabetic population and 0.804 in the nondiabetic population. High PLR predicted cirrhosis in the diabetic population, with an AUCROC of 0.824, whereas a high PLR was not associated with cirrhosis in the nondiabetic population. The restricted cubic spline revealed a negative linear correlation between the PLR and NAFLD incidence. The inflection point of the PLR for NAFLD was 180.74. A PLR ≤180.74 was statistically significant (odds ratio=0.997, 95% confidence interval=0.995-0.999). In the NAFLD population, the PLR was negatively correlated with cirrhosis at a PLR ≤130.5 (odds ratio=0.987, 95% confidence interval=0.977-0.996) and positively correlated with cirrhosis at a PLR > 130.5 (odds ratio=1.006, 95% confidence interval=1.001-1.012).

Conclusions

The PLR and NAFLD were negatively correlated in the U.S. population. The PLR had a U-shaped relationship with cirrhosis in the NAFLD population. The PLR has potential value in monitoring NAFLD patient progression to cirrhosis.

Values of a novel comprehensive prognostic nutritional index (FIDA) in the prognosis of non-small cell lung cancer

Background

This study focuses on determining the prognostic and predictive value of the comprehensive prognostic nutrition index (FIDA) in individuals undergoing treatment for Non-Small-Cell Lung Carcinoma (NSCLC).

Methods

This retrospective analysis encompassed 474 of NSCLC patients treated from January 2010 through December 2019. Employing the Lasso-COX regression approach, eight blood parameters were identified as significant prognostic indicators. These parameters contributed to the formulation of the comprehensive prognostic nutrition index FIDA. Utilizing X-tile software, the patient cohort was categorized into either a high or low FIDA group based on an established optimal threshold. The cohort was then randomly segmented into a training set and a validation set using SPSS software. Subsequent steps involved conducting univariate and multivariate regression analyze to develop a prognostic nomogram. The effectiveness of this nomogram was evaluated by calculating the AUC.

Results

Analysis of survival curves for both the training and validation sets revealed a poorer prognosis in the high FIDA group compared to the low FIDA group. This trend persisted across various subgroups, including gender, age, and smoking history, with a statistical significance (p<0.05). Time-dependent ROC and diagnostic ROC analyses affirmed that FIDA serves as an effective diagnostic and prognostic marker in NSCLC. Moreover, Cox regression multivariate analysis established FIDA as an independent prognostic factor for NSCLC. The prognostic nomogram, integrating FIDA and clinical data, demonstrated substantial prognostic utility and outperformed the traditional TNM staging systemin predicting overall survival (OS).

Conclusion

FIDA emerges as a dependable predictor of outcomes for patients with NSCLC. It offers a practical, cost-effective tool for prognostication in regular clinical applications.

Combined Serum ALBUMIN with Neutrophil-to-Lymphocyte Ratio Predicts the Prognosis of Biliary Tract Cancer after Curative Resection

BACKGROUND

The mainstay treatment of biliary tract cancer is complete tumor resection. Prior to surgery, risk stratification may help to predict and plan treatment approaches. In this study, we investigated the possibility of combining serum albumin concentrations and neutrophil-to-lymphocyte ratios (NLR) to create a score as ANS to predict the prognoses of biliary tract cancer before surgery.

METHODS

This study retrospectively collected serum albumin concentration, neutrophil, and lymphocyte data measured in biliary tract cancer patients slated to receive complete tumor resections within two weeks before surgery. From January 2013 to December 2019, 268 biliary tract cancer patients who had received tumor resections at our hospital were categorized into 3 ANS groups: ANS = 0 (high albumin and low NLR), ANS = 1 (low albumin or high NLR), and ANS = 2 (low albumin and high NLR).

RESULTS

Five-year survival rates were 70.1%, 47.6%, and 30.8% in the ANS = 0, 1, and 2 groups, respectively. The median overall survival time for the ANS = 0 group could not be determined by the end of the study, while those for ANS = 1 and ANS = 2 groups were 54.90 months and 16.62 months, respectively. The results of our multivariate analysis revealed that ANS could be used as an independent predictor of overall and recurrent-free survival. A high ANS was also correlated with other poor prognostic factors.

CONCLUSIONS

The ANS devised for this study can be used to predict postoperative survival in patients with BTC and to guide treatment strategies.

Prognostic Value of the Platelet-lymphocyte Ratio for Glioblastoma: A Systematic Review

BACKGROUND

Glioblastoma is the most common type of malignant glioma and is 1 of the most frequent primary tumors during adult life. The platelet-lymphocyte ratio (PLR) has been studied as an inflammatory marker associated with the prognosis of glioblastoma in previous studies. Considering the morbidity associated with this condition, it is important that there are other ways of assessing the prognosis that do not require invasive methods. Therefore, we performed this systematic review in order to determine the prognostic value of the PLR.

METHODS

We conducted an English language, literature-based search for papers published from 2012 to 2022, using the PubMed, Cochrane, Biblioteca Virtual em Saúde and Biomed Central Journal. We use the Preferred Reporting Items for Systematic Reviews and Meta-analyses recommendations. Titles and abstracts were evaluated independently by 2 authors, after which articles were selected for final analysis based on application of inclusion criteria (patients diagnosed with glioblastoma; address the use of PLR as a prognostic factor; hazard ratio; adults; clinical trials and observational studies) and exclusion criteria (inclusion of pediatric or animals, case reports, letters, conference abstracts, meta-analysis, and nonclinical studies or did not include hazard ratio) during full text screen. Each included article was then assessed for quality using Newcastle-Ottawa scale and relevant variables were extracted for synthesis.

RESULTS

Of 127 results, 11 articles were included for final analysis. There were 7 studies from China, 1 from Italy, 1 from Portugal, 1 from Turkey, and 1 from India. The years of publications were between 2015 and 2022. All the studies used PLR from the preoperative blood sample. Among the studies that analyzed the relationship between PLR and overall survival, 7 found a predictive relationship, 3 found no association, and 1 found an association between PLR and progression free survival in patients with glioblastoma.

CONCLUSIONS

Studies have shown that PLR can be a useful marker to aid in the prognosis of glioblastoma. Due to the ease of obtaining, rapid analysis and low cost, the PLR can be particularly beneficial in health centers with limited financial resources.

Evaluation of Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR) and Systemic Immune-Inflammation Index (SII) as Potential Biomarkers in Patients with Sporadic Medullary Thyroid Cancer (MTC)

Medullary thyroid cancer (MTC) is a rare neuroendocrine neoplasm, and calcitonin is its main biomarker. An elevated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) have been considered as negative prognostic factors in several neoplasms. The aim of this study is to evaluate the potential role of NLR, PLR and SII as biomarkers in MTC. Clinical data and tumor histological characteristics of patients with sporadic MTC, referred to the NET Unit of Federico II University of Naples (ENETS CoE) from 2012 to 2022, were retrospectively evaluated by analyzing preoperative and postoperative calcitonin, NLR, PLR and SII. We included 35 MTC patients undergoing total thyroidectomy. The mean preoperative NLR was 2.70 (±1.41, 0.93-7.98), the PLR was 121.05 (±41.9, 40.98-227.23) and SII was 597.92 (±345.58, 186.59-1628). We identified a statistically significant difference between pre- and post-thyroidectomy NLR (p = 0.02), SII (p = 0.02) and calcitonin (p = 0.0) values. No association with prognosis or tumor characteristics emerged. Elevated preoperative NLR and SII suggest a possible disease-associated inflammatory response, and their reduction after surgery may be related to debulking effects. Further studies are needed to define the role of NLR, PLR and SII as prognostic markers in MTC.

Prognostic and Clinical Value of the Systemic Immune-Inflammation Index in Biliary Tract Cancer: A Meta-Analysis

Previous studies that explored the prognostic and clinical value of the systemic immune-inflammation index (SII) in biliary tract cancer (BTC) had inconsistent results. We conducted this meta-analysis to evaluate the prognostic and clinicopathological role of the SII in biliary tract cancer. Combined analysis demonstrated that high SII levels had worse overall survival (HR = 1.92, 95% CI: 1.66-2.21, p < 0.001) than those with low SII levels. And an elevated SII was associated with lymph node metastasis (OR = 1.44, 95% CI = 1.18-1.76; p < 0.001), TNM stage (OR = 1.49, 95% CI = 1.05-2.13; p = 0.028), and vascular invasion (OR = 1.49, 95% CI = 1.05-2.13; p = 0.028). Conversely, no significant association between a high SII and sex or tumor differentiation was found. Our findings demonstrate that high SII levels were correlated with unfavorable survival outcomes among patients with BTC and that they were also correlated with some higher malignancy features of BTC.

A prognostic model in patients with advanced biliary tract cancer receiving first-line chemotherapy

BACKGROUND

Standard treatment of advanced biliary tract cancer (aBTC) is represented by first-line chemotherapy (CT1). However, some patients do not gain any benefit from CT1, contributing to the overall dismal prognosis of aBTC. The present study aimed to devise a prognostic model in aBTC patients receiving CT1.

METHODS

A large panel of clinical, laboratory, and pathology variables, available before the start of CT1, were retrospectively assessed in a multi-centric cohort to determine their prognostic value on univariate and multivariate regression analysis. The variables that showed a significant correlation with overall survival (OS) were computed in a three-tier prognostic score. External validation of the prognostication performance was carried out.

RESULTS

Clinical histories of 935 patients (median OS 10.3 months), with diagnosis dates ranging from 2001 to 2017, were retrieved from 14 institutions. According to multivariate analysis, Eastern Cooperative Oncology Group performance status, carbohydrate antigen 19.9, albumin levels, and neutrophil/lymphocyte ratio were strongly associated with OS (p <0.01). The prognostic score could generate a highly significant stratification (all between-group p values ≤0.001) into groups of favorable (comprising 51.5% of the sample), intermediate (39.2%), and poor prognosis (9.3%): median OS was 12.7 (CI_95% 11.0-14.4), 7.1 (CI_95% 5.8-8.4), and 3.2 months (CI_95% 1.7-4.7), respectively. This OS gradient was replicated in the validation set (129 patients), with median OS of 12.7 (CI_95% 11.0-14.3), 7.5 (CI_95% 6.1-8.9), and 1.4 months (CI_95% 0.1-2.7), respectively (all between-group p values ≤0.05).

CONCLUSION

A prognostic score, derived from a limited set of easily-retrievable variables, efficiently stratified a large population of unselected aBTC patients undergoing CT1. This tool could be useful to clinicians, to ascertain the potential benefit from CT1 at the start of treatment.

The prognostic impact of neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) in patients with distal bile duct cancer

Background

A growing body of evidence suggests that inflammatory response markers such as the neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) are associated with outcomes of various malignancies. However, no study has reported the prognostic value of NLR and LMR in patients with distal bile duct cancer (DBDC) to date. We investigated the prognostic significance of these inflammatory markers in patients with DBDC who underwent radical resection.

Methods

The study included 40 patients diagnosed with DBDC who underwent pancreaticoduodenectomy at Narita Red Cross Hospital between January 2000 and December 2017. The cutoff values for these markers were determined by receiver operating characteristic curve analysis. Survival curves are estimated for each group in the study considered separately using the Kaplan-Meier method. The association between overall survival (OS) and the NLR, LMR, and other prognostic factors was investigated using log-rank test and multivariate Cox proportional hazards regression analysis.

Results

Corresponding to the point with the maximum combined sensitivity and specificity on the ROC curve, the best cutoff value for NLR and LMR was determined to be 3.14 and 4.55, respectively. Most clinicopathological factors were not associated with the NLR and LMR based on these cutoff values. However, serum albumin levels were associated with both the NLR and LMR (P = 0.011 and P = 0.023, respectively), and serum carbohydrate antigen 19-9 (CA 19-9) levels were also associated with the LMR (P = 0.030). Univariate analysis showed that a high NLR (P < 0.001), low LMR (P = 0.002), hypoalbuminemia (P = 0.004), high serum CA 19-9 levels (P = 0.008), and lymph node metastasis (P = 0.033) were significantly associated with poor survival rates. Multivariate analysis showed that a high NLR (hazard ratio 5.799, 95% confidence interval 1.188–28.32, P = 0.030) and a low LMR (hazard ratio 4.837, 95% confidence interval 1.826–2.331, P = 0.025) were independent prognostic factors for OS.

Conclusion

Both NLR and LMR may serve as significant independent preoperative prognostic indicators of disease in patients with DBDC who undergo radical resection.

Preoperative lymphocyte-to-monocyte ratio versus platelet-to-lymphocyte ratio as a prognostic predictor for non-small cell lung cancer patients

Background

We investigated the prognostic value of the preoperative lymphocyte-to-mononuclear ratio (LMR) and platelet-to-lymphocyte ratio (PLR) in a large cohort of patients with non-small cell lung cancer (NSCLC).

Methods

Clinical-pathological data from 507 NSCLC patients at Taizhou Hospital of Zhejiang Province between 2010 and 2016 were retrospectively evaluated. X-tile software was used to assess the optimal cutoff levels for LMR and PLR. Univariate and multivariate Cox regression models were used to assess the prognostic factors.

Results

The median follow-up duration after surgical resection was 34.5 months. Patients were stratified into 2 groups by LMR (2.6 and > 2.6) and PLR (179.6 and > 179.6). Our results revealed that lower LMR (HR = 3.163 (1.821-5.493), P = 0.000), age (HR = 2.252 (1.412-3.592), P = 0.001), T stage (HR = 3.749 (2.275-6.179), P = 0.000), N stage (HR = 3.106 (1.967-4.902), P = 0.000), and cut edge (HR = 3.830 (1.077-13.618), P = 0.038) were considered to be independent indicators for overall survival (OS) of NSCLC patients. For disease-free survival (DFS), age, sex, T stage, N stage, LMR and cut edge were verified to be independent prognostic factors in patients with NSCLC.

Conclusions

In the study cohort, reduced LMR was a robust independent predictor for both OS and DFS in patients with NSCLC who underwent surgical resection.

Pharmacotherapeutic options for biliary tract cancer: current standard of care and new perspectives

Introduction: Biliary tract cancer (BTC), which comprises gallbladder cancer, ampullary cancer, and cholangiocarcinoma, is a rare and heterogeneous entity, with limited approved therapeutic options. However, interest in this disease has grown exponentially in recent years, as a mounting body of evidence has shed light on the complex molecular and microenvironmental background of BTC, and clinical investigations have explored a variety of new agents and combinations, with promising results.Areas covered: This review describes the standard of care in advanced BTC and summarizes the most recent evidence available on the pharmacological treatment of resected and advanced disease, focusing on chemotherapy, targeted therapy, and immunotherapy.Expert opinion: The therapeutic armamentarium of BTC has made radical progress after almost a decade of very few positive results. Phase-III evidence now supports the use of adjuvant capecitabine after resection of localized disease, while investigations into improved regimens in the advanced setting are underway, exploring alternative options to the standard gemcitabine-cisplatin doublet. The first positive phase-III trial supports the use of the mFOLFOX6 regimen as a second-line chemotherapy. Targeted therapy against specific genomic alterations can combine with chemotherapy in specific subsets of patients. Despite recent advancements, conducting clinical trials for BTC is still a real challenge.

Combined Plasma Fibrinogen and Neutrophil Lymphocyte Ratio in Ovarian Cancer Prognosis May Play a Role?

OBJECTIVES

In ovarian cancer (OC), approximately 70% will relapse within 12 months from diagnosis; inflammation plays an important role in cancer initiating and progression; thus, a combination of neutrophil-to-lymphocyte ratio (NLR) and fibrinogen (F-NLR) has been proposed as prognostic marker in several tumors. The aim of our study was to investigate the correlation between NLR, fibrinogen, and F-NLR and survival in OC population.

METHODS

Patients with diagnosis of OC admitted to our institute between 2011 and 2016 were included. Data about pretreatment complete blood count were collected. Neutrophil-to-lymphocyte ratio was defined as the absolute neutrophil count divided by the absolute lymphocyte count; the F-NLR score was 0 for low NLR and fibrinogen, 1 for low NLR and high fibrinogen, or, conversely, 2 for both high markers. We correlated this index with progression-free survival.

RESULTS

A total of 94 patients were enrolled. Median age at diagnosis was 55 (34-83) years; more than 80% of patients presented International Federation of Gynecology and Obstetrics stage III-IV at diagnosis, and 72 (77%) presented high-grade serous histology. Primary debulking surgery was performed in 57 women (60%), whereas 37 (40%) underwent interval debulking surgery.Mean serum NLR was 5.25 ± 5.37, and mean serum fibrinogen value was 4.19 ± 0.97 g/L. The median follow-up time was 27 months (range, 8-60 months). All patients with F-NLR value of 2 presented advanced disease compared with 64% of those with F-NLR of 0 (P < 0.031); these patients more frequently required neoadjuvant chemotherapy (P < 0.003) and more often had platinum-resistant disease (P < 0.022). Patients with high F-NLR presented worse progression-free survival than did patients with low F-NLR (12 vs 42 months, respectively, P = 0.023).

CONCLUSIONS

Combining NLR and fibrinogen levels could be used as a factor for prediction of prognosis and response to treatment in patients affected with OC.

Clinical significance of neutrophil-lymphocyte and platelet-lymphocyte ratios in bipolar patients: An 18-month prospective study

Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have recently been investigated as inexpensive and reproducible markers of systemic inflammation in many diseases. However, few studies evaluate clinical and prognostic value of NLR and PLR in psychiatric patients. The objective of this study is to investigate the clinical repercussions of NLR and PLR in patients with bipolar disorder (BD). An 18-month prospective study followed up eighty euthymic BD outpatients. Baseline data included an interviewer-administered questionnaire, behavioral scales and a blood count to calculate NLR and PLR. The occurrence of mood episodes and hospitalizations was assessed monthly for 18 months. Higher NLR and PRL were associated with more anxious symptoms and poorer functioning. BD patients with Night Eating Syndrome (NES) had higher PLR and tended to higher NLR. No association with other sleep parameters was evidenced. Higher NLR and PRL were also associated with more episodes and hospitalizations after 18 months. However, only higher baseline NLR was related to more (hypo)mania episodes. NLR and PLR are important prognostic factor for BD. This study suggested the importance of a simple blood count, an inexpensive and reproducible exam, in evaluating the course of the BD. Further studies must be performed to confirm these results.

The impact of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio among patients with intrahepatic cholangiocarcinoma

BACKGROUND

Neutrophil-to-lymphocyte ratio and platelets-to-lymphocyte ratio may be host factors associated with prognosis. We sought to determine whether neutrophil-to-lymphocyte and platelets-to-lymphocyte ratio were associated with overall survival among patients undergoing surgery for intrahepatic cholangiocarcinoma.

METHODS

Patients who underwent resection for intrahepatic cholangiocarcinoma between 1990 and 2015 were identified from 12 major centers. Clinicopathologic factors and overall survival were compared among patients stratified by neutrophil-to-lymphocyte ratio and platelets-to-lymphocyte ratio. Risk factors identified on multivariable analysis were included in a prognostic model and the discrimination was assessed using Harrell's concordance index (C index).

RESULTS

A total of 991 patients were identified. Median neutrophil-to-lymphocyte ratio and platelets-to-lymphocyte ratio were 2.7 (interquartile range [IQR]: 2.0-4.0) and 109.6 (IQR: 72.4-158.8), respectively. Preoperative neutrophil-to-lymphocyte ratio was elevated (≥5) in 100 patients (10.0%) and preoperative platelets-to-lymphocyte ratio (≥190) in 94 patients (15.2%). Patients with low and high neutrophil-to-lymphocyte ratio and platelets-to-lymphocyte ratio generally had similar baseline characteristics with regard to tumor characteristics. Overall survival was 37.7 months (95% confidence interval [CI]: 32.7-42.6); 1-, 3-, and 5-year overall survival was 78.8%, 51.6%, and 39.3%, respectively. Patients with an neutrophil-to-lymphocyte ratio <5 had a median survival of 47.1 months (95% CI: 37.9-53.3) compared with a median survival of 21.9 months (95% CI: 4.8-39.1) among patients with an neutrophil-to-lymphocyte ratio ≥5 (P = .001). In contrast, patients who had a platelets-to-lymphocyte ratio <190 vs platelets-to-lymphocyte ratio ≥190 had comparable long-term survival (P > .05). On multivariable analysis, an elevated neutrophil-to-lymphocyte ratio was independently associated with decreased overall survival (hazard ratio: 1.04, 95% CI: 1.01-1.07; P = .002). Patients could be stratified into low- versus high-risk groups based on standard tumor-specific factors such as lymph node status, tumor size, number, and vascular invasion (C index 0.62). When neutrophil-to-lymphocyte ratio was added to the prognostic model, the discriminatory ability of the model improved (C index 0.71).

CONCLUSION

Elevated neutrophil-to-lymphocyte ratio was independently associated with worse overall survival and improved the prognostic estimation of long-term survival among patients with intrahepatic cholangiocarcinoma undergoing resection.

Increased platelet-to-lymphocytes ratio is associated with poor long-term prognosis in patients with pancreatic cancer after surgery

Several studies reported platelet-to-lymphocytes ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) were associated with the mid-term survival or cancer stage in pancreatic cancer. However, the relationship between these markers and the long-term prognosis of pancreatic cancer is still unknown. We investigated the relationship between PLR, NLR, RDW, and the long-term prognosis of pancreatic cancer.We included 182 pancreatic cancer patients who received operation at Linzi District People 's Hospital between August 2010 and January 2017. PLR, NLR, and RDW control data was obtained from 150 health volunteers from January 2011 to January 2017. Blood biochemical data before operation, preoperative computed tomography information, and pathological data of the pancreatic cancer patients were retrospectively collected for further analysis. Independent long-term prognostic significance of PLR, NLR, and RDW were analyzed in pancreatic cancer patients.PLR, NLR, and RDW were significantly increased in pancreatic cancer group compared with the control. Receiver operating characteristic (ROC) curve analysis showed the optimal cut-off values of PLR, NLR, and RDW were 150, 1.73, and 13.2 respectively. Overall survival (OS) analysis showed pancreatic cancer patients with PLR≥150 (median time, 24 vs 37.5 months, P = .005) or RDW≥13.2 (median time, 27 months vs 37.5 months, P = .018) had lower postoperative 5 year OS compared with pancreatic cancer patients with PLR<150 or RDW<13.2. Univariate and multivariable Cox regression analysis for postoperative 5 year OS data showed PLR≥150 (HR = 2.451, 95% CI 1.215-4.947; P = .012) was still associated with the OS independently. Disease free survival (DFS) analysis showed pancreatic cancer patients with PLR≥150 (median time, 24 months vs 38 months, P = .002) or RDW≥13.2 (median time, 24 months vs 37.5 months, P = .006) had lower postoperative 5 year DFS compared with pancreatic cancer patients with PLR<150 or RDW<13.2. Univariate and multivariable Cox regression analysis for postoperative 5 year DFS data showed PLR≥150 (HR = 2.712, 95% CI 1.367-5.379; P = .004) was independently associated with the DFS.In the present study, we find hematological biomarkers PLR≥150 is an independently predictive risk factor for the postoperative long-term prognosis in pancreatic cancer patients. Our study may provide a convenient way for the prognostic assessment of pancreatic cancer patients.