Higher Neutrophil-to-Lymphocyte Ratio and Systemic Immune–Inflammation Index Is Associated with Better Prognosis Following Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

Kazlow, Esther; Rinawi, Elias; Gerszman, Eden; Mattar, Samar; Essami, Nabih; Nasir, Mary; Abu Shtaya, Aasem; Assaf, Wisam; Haddad, Riad; Mahamid, Ahmad

doi:10.3390/jcm14113762

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Higher Neutrophil-to-Lymphocyte Ratio and Systemic Immune–Inflammation Index Is Associated with Better Prognosis Following Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

by

Esther Kazlow

^1,2,

Elias Rinawi

^1,2,

Eden Gerszman

^1,2,

Samar Mattar

^1,2,

Nabih Essami

^1,2,

Mary Nasir

^1,2,

Aasem Abu Shtaya

^1,3,

Wisam Assaf

^1,4,

Riad Haddad

^1,2

and

Ahmad Mahamid

^1,2,*

¹

Technion Israel Institute of Technology, Rappaport Faculty of Medicine, Haifa 3109601, Israel

²

Department of Surgery, Carmel Medical Center, Michal Str. 7, Haifa 3436212, Israel

³

Department of Gastroenterology, Carmel Medical Center, Haifa 3436212, Israel

⁴

Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa 3436212, Israel

^*

Author to whom correspondence should be addressed.

J. Clin. Med. 2025, 14(11), 3762; https://doi.org/10.3390/jcm14113762

Submission received: 9 April 2025 / Revised: 16 May 2025 / Accepted: 26 May 2025 / Published: 27 May 2025

(This article belongs to the Special Issue Advanced Hepato-Pancreato-Biliary Surgery: Clinical Innovations and Improved Outcomes)

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Abstract

Background: Pancreatic cancer has a high mortality rate worldwide. Most patients progress to advanced stages, often with metastasis, resulting in a low survival rate. Despite advancements in surgical and oncological treatments, early diagnosis and better risk stratification remain critical. Methods: This retrospective cross-sectional study focused on analyzing data from patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, in order to determine whether the neutrophil-to-lymphocyte ratio (NLR) and other immune–inflammatory markers, such as the systemic immune–inflammation index (SII) and prognostic nutritional index (PNI), can predict postoperative complications and survival outcomes. Results: Analysis of 136 patients revealed that a higher NLR (≥2.5) was significantly associated with longer overall survival (39 months, IQR: 17–100 months; p = 0.004), compared to lower NLR (<2.5; 18 months, IQR: 9–39 months). Higher SII (≥600) was also associated with significantly improved survival (34 months, IQR: 17–114 months; p = 0.001) compared to lower SII (<600; 20 months, IQR: 9–45 months). No significant differences were observed in postoperative complications or other clinical outcomes between NLR groups, although a trend toward more complications in the higher NLR group was noted (p = 0.06). PNI showed no significant impact on survival (PNI < 38.8: 22 months, IQR: 14–60 months; PNI ≥ 38.8: 33 months, IQR: 14–115 months; p = 0.1) or complications (p = 0.8). Conclusions: Our study highlights the prognostic utility of NLR and SII in patients with adenocarcinoma of the head of the pancreas undergoing pancreaticoduodenectomy. Regarding complications, there were no significant differences across groups stratified by NLR, SII, or PNI, suggesting that while NLR and SII are valuable for predicting long-term oncological outcomes in patients undergoing pancreaticoduodenectomy for adenocarcinoma of the head of the pancreas, they may not be reliable indicators of immediate postoperative morbidity.

Keywords: pancreatic cancer; neutrophil-to-lymphocyte ratio (NLR); systemic immune–inflammation index (SII); prognostic nutritional index (PNI); pancreaticoduodenectomy; survival outcomes; complications

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MDPI and ACS Style

Kazlow, E.; Rinawi, E.; Gerszman, E.; Mattar, S.; Essami, N.; Nasir, M.; Abu Shtaya, A.; Assaf, W.; Haddad, R.; Mahamid, A. Higher Neutrophil-to-Lymphocyte Ratio and Systemic Immune–Inflammation Index Is Associated with Better Prognosis Following Pancreaticoduodenectomy for Pancreatic Adenocarcinoma. J. Clin. Med. 2025, 14, 3762. https://doi.org/10.3390/jcm14113762

AMA Style

Kazlow E, Rinawi E, Gerszman E, Mattar S, Essami N, Nasir M, Abu Shtaya A, Assaf W, Haddad R, Mahamid A. Higher Neutrophil-to-Lymphocyte Ratio and Systemic Immune–Inflammation Index Is Associated with Better Prognosis Following Pancreaticoduodenectomy for Pancreatic Adenocarcinoma. Journal of Clinical Medicine. 2025; 14(11):3762. https://doi.org/10.3390/jcm14113762

Chicago/Turabian Style

Kazlow, Esther, Elias Rinawi, Eden Gerszman, Samar Mattar, Nabih Essami, Mary Nasir, Aasem Abu Shtaya, Wisam Assaf, Riad Haddad, and Ahmad Mahamid. 2025. "Higher Neutrophil-to-Lymphocyte Ratio and Systemic Immune–Inflammation Index Is Associated with Better Prognosis Following Pancreaticoduodenectomy for Pancreatic Adenocarcinoma" Journal of Clinical Medicine 14, no. 11: 3762. https://doi.org/10.3390/jcm14113762

APA Style

Kazlow, E., Rinawi, E., Gerszman, E., Mattar, S., Essami, N., Nasir, M., Abu Shtaya, A., Assaf, W., Haddad, R., & Mahamid, A. (2025). Higher Neutrophil-to-Lymphocyte Ratio and Systemic Immune–Inflammation Index Is Associated with Better Prognosis Following Pancreaticoduodenectomy for Pancreatic Adenocarcinoma. Journal of Clinical Medicine, 14(11), 3762. https://doi.org/10.3390/jcm14113762

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Higher Neutrophil-to-Lymphocyte Ratio and Systemic Immune–Inflammation Index Is Associated with Better Prognosis Following Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

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