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Preoperative neutrophil‐to‐lymphocyte ratio (NLR) predicts recurrence after surgery in patient with pancreatic neuroendocrine neoplasm (PanNEN)


23 Nov 2019


Poster display session


Takayuki Miura


Annals of Oncology (2019) 30 (suppl_9): ix42-ix67. 10.1093/annonc/mdz422


T. Miura1, T. Aoki1, H. Ohtsuka1, S. Aoki1, T. Hata1, M. Iseki1, T. Takadate1, K. Ariake1, K. Kawaguchi1, K. Masuda1, M. Ishida1, M. Mizuma1, H. Hayashi1, K. Nakagawa1, T. Morikawa1, F. Motoi1, H. Sasano2, T. Naitoh1, T. Kamei1, M. Unno1

Author affiliations

  • 1 Department Of Surgery, Tohoku University Graduate School of Medicine, 980-8574 - Sendai/JP
  • 2 Department Of Pathology, Tohoku University Graduate School of Medicine, 980-8574 - Sendai/JP



Several inflammation-based markers were found to have a prognostic value in malignancies. Recent studies have reported that the preoperative neutrophil-to-lymphocyte ratio (NLR) is useful for prognostication in a variety of oncologic patients. We analyzed the NLR in determining Pancreatic neuroendocrine neoplasm (PanNEN) clinical outcomes after surgery.


We evaluated 132 consecutive cases of PanNEN who underwent surgery in Tohoku University Hospital between May 2001 and December 2018. Eight patients with synchronous hepatic metastasis, two patients with NEC, one patient with an active infection at blood sampling, and one patient with R2 noncurative resection were excluded from the study. 120 patients divided into two groups according to the values of NLR based on the receiver operator characteristic (ROC) curve. Differences of the characteristics between the two NLR groups (<3.84 vs. ≥3.84) were investigated with the chi-squared test and the Wilcoxon rank-sum test. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated by univariate or multivariate analyses using Cox’s proportional hazards model.


The median age was 60 years old (range 12-88). In the WHO2017 histological grade, NET G1, G2, and G3 included 74, 44, and 2 cases, respectively. The median follow-up period was 52.9 months (range, 1-182). The NLR values distributed between 0.44 and 5.32 (average 1.92 ± 0.88). Five- and ten‐year RFS was 90.4% and 80.1%, respectively. Ten (8.3%) cases of relapse were observed. The site of recurrence was liver in nine patients and lymph node metastasis in one. NLR showed a significant correlation with RFS (median RFS time, 44.6 months (NLR ≥ 3.84) and not reached (NLR <3.84), p < 0.001). The multivariate analysis identified ki67 (≥3.4 HR 8.9; 95% CI 2.14 to 60.3; P = 0.002), and preoperative NLR (≥3.84 HR 7.7; 95% CI 1.63 to 30.1; P = 0.013) were an independent predictor of recurrence.


NLR could be a useful prognostic marker of the recurrence estimation after surgery and a handy objective screening tool for the host immune response in patients with PanNEN.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.


Has not received any funding.


All authors have declared no conflicts of interest.

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