The role of lymphocyte-to-monocyte ratio as a prognostic index to predict poor prognosis in patients with unresectable pancreatic cancer treated with chemotherapy

Background Pancreatic cancer is associated with poor prognosis. Several biomarkers are present for predicting prognosis but predicting chemotherapy response is challenging. Lymphocyte-to-monocyte ratio (LMR) has emerged as a promising prognostic indicator. We aim to predict the response of patients to chemotherapy according to the LMR and detect how it is relevant as an indicator for poor outcomes, choose the optimal therapeutic strategies, and improve the outcome. Patients and methods This study included 50 patients with unresectable pancreatic cancer presented to the Alexandria Clinical Oncology Department from January 2020 to December 2022 and treated with chemotherapy. This study has been approved by the Ethics Committee, Faculty of Medicine, Alexandria University, and accepted according to Ethical Standards of Scientific Research on June 11, 2023. The files were reviewed, and the complete blood count (CBC) before and after the chemotherapy start were retrieved. Results Mean age was 58.14. No statistically significant difference observed in the mean lymphocyte and monocyte counts before and after one month of chemotherapy. 16% of the patients showed disease progression. The mean overall survival (OS) and progression-free survival (PFS) were 17.24 and 19.74 months. Patients with high LMR1 had significantly higher mean OS and PFS (24 months) compared with those with low LMR1 There was a statistically significant difference in mean OS and PFS as well as treatment response and disease progression between patients with low LMR2 and those with high LMR2. Conclusions Our study suggests that high pretreatment LMR is associated with better OS, PFS, and treatment response in unresectable pancreatic cancer patients treated with chemotherapy so, LMR can be used for predicting treatment response and survival outcomes and change management accordingly.