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Inflammation-Based Hematological Indices (NLR, PLR, LMR) in Pancreatic Cancer: Implications for Laboratory Diagnostics and Clinical Interpretation
by
,
Iwona Zawistowska
1,*, 
Blanka Wolszczak-Biedrzycka
2,
Tomasz Kukliński
3,
Violetta Dymicka-Piekarska
4 and 
Justyna Dorf
4,* 1
Medical Laboratory Diagnostic, Polish Red Cross Memorial Municipal Hospital, Henryka Sienkiewicza 79 St., 15-003 Bialystok, Poland
2
Department of Psychology and Sociology of Health and Public Health, University of Warmia and Mazury in Olsztyn, Warszawska 30 St., 10-082 Olsztyn, Poland
3
Department of Internal Medicine and Gastroenterology, Independent Public Health Care Center of the Ministry of Internal Affairs and Administration in Białystok Marian Zyndram–Kościałkowski, Fabryczna 27 St., 15-471 Bialystok, Poland
4
Department of Clinical Laboratory Diagnostics, Medical University of Bialystok, Waszyngtona 15a St., 15-269 Bialystok, Poland
*
Authors to whom correspondence should be addressed.
Cancers 2026, 18(14), 2313; https://doi.org/10.3390/cancers18142313 (registering DOI)
Submission received: 15 June 2026
/
Revised: 7 July 2026
/
Accepted: 15 July 2026
/
Published: 17 July 2026
(This article belongs to the Special Issue Role of Cancer Biomarkers for Diagnosis, Prognosis and Targeted Therapy in Gastrointestinal Cancers)
Simple Summary
Pancreatic cancer is one of the most dangerous and common cancers. Its invasiveness and high metastatic potential result from the specific tumor microenvironment, in which inflammation plays a key role. Prompt diagnosis is crucial, allowing for the implementation of appropriate treatment at an early stage. The aim of our review is to assess the clinical utility of hematological indicators related to inflammation found in routine blood tests, such as complete peripheral blood counts: the neutrophil-to-lymphocyte ratio (NLR), the lymphocyte-to-monocyte ratio (LMR), and the platelet-to-lymphocyte ratio (PLR). We have demonstrated that elevated NLRs and PLRs, as well as decreased LMR, characterize patients with poorer prognosis and overall survival. Due to their low cost and widespread availability, these indicators may become valuable prognostic biomarkers for pancreatic cancer, supporting faster therapeutic decision-making and improving patient prognosis.
Abstract
Objectives: Pancreatic cancer remains one of the most aggressive malignancies, characterized by late diagnosis, limited therapeutic options, and poor survival outcomes. Increasing evidence indicates that systemic inflammation and tumor microenvironment interactions play a crucial role in disease progression and patient prognosis. This review aims to summarize current evidence on the clinical utility of inflammation-based hematological indices derived from complete blood count (CBC), including the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR), in pancreatic cancer. Content: Available data consistently demonstrate that elevated NLR and PLR, as well as decreased LMR, are associated with poorer overall survival, more aggressive disease phenotype, and reduced response to therapy. Among these indices, NLR appears to be the most robust and widely validated prognostic marker. Its clinical value is enhanced when combined with markers such as CA 19-9. LMR reflects the balance between host immune response and monocyte-derived tumor-promoting activity, while PLR highlights the role of platelets in tumor progression, angiogenesis, and immune evasion. Despite their potential, the routine clinical implementation of these indices is limited by the lack of standardized cut-off values, variability between patient populations, and susceptibility to confounding factors such as inflammatory conditions. Summary and outlook: In this article we show that inflammation-based hematological indices represent inexpensive, accessible, and promising tools for laboratory diagnostics and prognostic assessment in pancreatic cancer. Their integration with clinical, biochemical, and molecular data may improve risk stratification and support personalized therapeutic strategies; however, further large-scale prospective studies are required to establish their standardized clinical use.
Keywords:
LMR; NLR; pancreatic cancer; PDAC; PLR
