ArticleFrontiers in molecular biosciences2026
Baseline and dynamic neutrophil-to-lymphocyte ratio predicts overall survival in unresectable pancreatic cancer following dose-escalated SBRT: a ten-year longitudinal study.
Article in Frontiers in molecular biosciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Systemic inflammation is closely associated with progression and therapeutic resistance in pancreatic ductal adenocarcinoma (PDAC). The neutrophil-to-lymphocyte ratio (NLR) serves as a surrogate for the balance between pro-tumor inflammation and adaptive anti-tumor immunity. This study evaluated whether baseline NLR and early post-treatment NLR dynamics were associated with overall survival (OS) in patients with unresectable or medically inoperable PDAC receiving dose-escalated stereotactic body radiation therapy (SBRT). Methods: We retrospectively analyzed 68 patients with unresectable or medically inoperable PDAC treated with dose-escalated SBRT between January 2013 and December 2023. Baseline NLR was measured within 14 days prior to SBRT, and post-treatment NLR was reassessed approximately 4 weeks after SBRT. The optimal NLR threshold was determined using receiver operating characteristic (ROC) curve analysis for 12-month mortality and was interpreted as an exploratory, cohort-derived cut-off. Survival was estimated using the Kaplan-Meier method, Cox proportional hazards models, and restricted cubic splines (RCS). Clinical utility was Results: An ROC-derived NLR threshold of 2.96 was identified, demonstrating high discriminatory power with an AUC of 0.872 (p < 0.001). Patients in the NLR-low group (n = 39) achieved a significantly longer median OS compared to the NLR-high group (n = 29) (21.0 vs. 9.0 months, p < 0.0001). In multivariable analysis, NLR < 2.96 remained independently associated with improved OS (Hazard Ratio [HR] = 0.12; 95% CI: 0.06-0.27, p < 0.001) after adjusting for ECOG performance status, M stage, chemotherapy, tumor diameter, albumin, CA19-9, and BED10. Dynamic monitoring showed that patients with "Stably Low" or "Improved" NLR status post-SBRT had significantly better outcomes (p = 0.00084). Joint stratification with CA19-9 further enhanced risk groups, and DCA suggested improved net clinical benefit after incorporating NLR into risk models. No grade 4 or 5 treatment-related toxicities were observed. Conclusion: Pre-treatment and dynamic NLR may serve as accessible immune-inflammatory biomarkers for patients with unresectable or medically inoperable PDAC undergoing dose-escalated SBRT. The threshold of 2.96 should be regarded as an exploratory cohort-derived value rather than a definitive clinical cut-off, and external validation is required before routine clinical implementation.
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