Baseline neutrophil-to-eosinophil ratio and neutrophil-to-lymphocyte ratio as prognostic markers in patients with unresectable biliary tract cancer treated with gemcitabine-cisplatin-durvalumab: an international, multicentre, retrospective cohort stu

Background: A combination of gemcitabine, cisplatin and durvalumab (anti-programmed death-ligand 1) is the current standard-of-care first-line therapy for advanced biliary tract cancer (BTC).To date, there is only limited evidence regarding prognostic biomarkers.Studies in other tumour types treated with immune checkpoint inhibitors have highlighted the pretreatment neutrophil-to-eosinophil ratio (NER) and neutrophil-to-lymphocyte ratio (NLR) as potential prognostic biomarkers for response to immunochemotherapy.Our aim is to investigate whether NER and NLR can serve as potential prognostic biomarkers in advanced BTC. Materials and methods: Patient data were retrospectively collected from 39 sites in 11 countries.The study population comprised patients with unresectable, locally advanced, or metastatic BTCs.The primary outcome was overall survival (OS).The secondary outcomes were progression-free survival (PFS) and objective response rate (ORR).Results: A total of 509 patients were included in the analysis.In a multivariate Cox regression model, OS and PFS were significantly shorter for patients with NLR above the median value (OS: hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.44-3.00,P < 0.001 and PFS: HR 1.57, 95% CI 1.17-2.10,P = 0.002).These associations were not found based on NER.There was no significant difference in ORR between patients stratified based on NER or NLR values.Conclusion: A higher baseline NLR was significantly associated with worse PFS and OS.No significant association was found between NER and OS or PFS.These findings suggest that NLR can serve as a prognostic biomarker for patients with advanced BTC treated with gemcitabine-cisplatin-durvalumab.

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Journal
ESMO Gastrointestinal Oncology
Published
2026-05-08
DOI
https://doi.org/10.1016/j.esmogo.2026.100335
Primary Topic
Inflammatory Biomarkers in Disease Prognosis
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article
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article

Baseline neutrophil-to-eosinophil ratio and neutrophil-to-lymphocyte ratio as prognostic markers in patients with unresectable biliary tract cancer treated with gemcitabine-cisplatin-durvalumab: an international, multicentre, retrospective cohort stu

M.G. Rodriquenz, C. Pircher, H.J. Chon, Jae‐Joong Kim et al.
ESMO Gastrointestinal Oncology
Inflammatory Biomarkers in Disease Prognosis
article

Baseline neutrophil-to-eosinophil ratio and neutrophil-to-lymphocyte ratio as prognostic markers in patients with unresectable biliary tract cancer treated with gemcitabine-cisplatin-durvalumab: an international, multicentre, retrospective cohort stu

M.G. Rodriquenz, C. Pircher, H.J. Chon, Jae‐Joong Kim, M. Landriscina, G. W. Prager, A. De Rosa, F. Finkelmeier, F. Nichetti, E. Tamburini, A. Boccaccino, A. Parisi, J. Lucchetti, A. Saborowski, C. Braconi, N. Personeni, M. Ferrara, F. Castet, M. Schirripa, F. Lo Prinzi, D. Lavacchi, C. Yoo, O. Abidoye, I. Lanzetta, S. Leo, M. Verrico, L Antonuzzo, G. Giordano, J. Dekervel, M. Niger, R. Balsano, C. Vivaldi, I.G. Rapposelli, I. Garajova, S. Camera, A. Casadei-Gardini, A. Lancianese, L. Perkhofer, L. Fornaro, J. Adeva, E. Oneda, C. Pirrone, N. Couto, G. Tonini, A. Qaisar, L. Passeri, M. Persano, M. Scartozzi, A. Diana, S. Corallo, M. Ikeda, T. Pressiani, F. Salani, A. Vogel, S.A. Djaballah, T. Satake, T. Bekaii-Saab, H. Vandeputte, G.P. Spinelli, M. Rimini, S. Lonardi, S. Tamberi, R. Roque, M. Kang, A. Avallone, G. Farinea, F. Peeters, L. Rimassa, V. Himmelsbach, I.H. Kim, G. Tesini, S.L. Chan, L. Esposito, C.M. Alvim
article en

Abstract

Background: A combination of gemcitabine, cisplatin and durvalumab (anti-programmed death-ligand 1) is the current standard-of-care first-line therapy for advanced biliary tract cancer (BTC).To date, there is only limited evidence regarding prognostic biomarkers.Studies in other tumour types treated with immune checkpoint inhibitors have highlighted the pretreatment neutrophil-to-eosinophil ratio (NER) and neutrophil-to-lymphocyte ratio (NLR) as potential prognostic biomarkers for response to immunochemotherapy.Our aim is to investigate whether NER and NLR can serve as potential prognostic biomarkers in advanced BTC. Materials and methods: Patient data were retrospectively collected from 39 sites in 11 countries.The study population comprised patients with unresectable, locally advanced, or metastatic BTCs.The primary outcome was overall survival (OS).The secondary outcomes were progression-free survival (PFS) and objective response rate (ORR).Results: A total of 509 patients were included in the analysis.In a multivariate Cox regression model, OS and PFS were significantly shorter for patients with NLR above the median value (OS: hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.44-3.00,P < 0.001 and PFS: HR 1.57, 95% CI 1.17-2.10,P = 0.002).These associations were not found based on NER.There was no significant difference in ORR between patients stratified based on NER or NLR values.Conclusion: A higher baseline NLR was significantly associated with worse PFS and OS.No significant association was found between NER and OS or PFS.These findings suggest that NLR can serve as a prognostic biomarker for patients with advanced BTC treated with gemcitabine-cisplatin-durvalumab.

ESMO Gastrointestinal OncologyVol. 12
University of Foggia (IT), University of Pisa (IT), Champalimaud Foundation (PT), Goethe University Frankfurt (DE), Ulsan College (KR), Marche Polytechnic University (IT), Hebron University (PS), University of Parma (IT), Humanitas University (IT), University of Padua (IT), Vita-Salute San Raffaele University (IT), Università Campus Bio-Medico (IT), Instituto Português de Oncologia de Coimbra Francisco Gentil (PT), University of Cagliari (IT), Chinese University of Hong Kong (HK), University of Pavia (IT), Casa Sollievo della Sofferenza (IT), Policlinico Umberto I (IT), Beatson West of Scotland Cancer Centre (GB), Princess Margaret Cancer Centre (CA), Seoul National University Bundang Hospital (KR), Medizinische Hochschule Hannover (DE), University of Ulsan (KR), Ospedali Riuniti di Foggia (IT), Ospedale "Santa Maria delle Croci" di Ravenna (IT), Ospedale di Cattinara (IT), Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IT), Hospital Universitario 12 De Octubre (ES), Inje University Haeundae Paik Hospital (KR), Casa di Cura Villa Garda (IT), Istituto Oncologico Veneto (IT), Prince of Wales Hospital (CN), Azienda Ospedaliero-Universitaria Careggi (IT), Mayo Clinic in Arizona (US), Ospedale di Belcolle (IT), Mayo Clinic Hospital (US), University Hospital Frankfurt (DE), CHA University Bundang Medical Center (KR), Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (IT), Campus Bio Medico University Hospital (IT), National Cancer Center Hospital East (JP), Ospedale Policlinico San Martino (IT), Fondazione Poliambulanza Istituto Ospedaliero (IT), Hospital de Santa Maria (PT), Policlinico San Matteo Fondazione (IT), Ospedale Vito Fazzi (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), University Hospital Ulm (DE), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), IRCCS Humanitas Research Hospital (IT), Azienda Ospedaliera Universitaria Pisana (IT), University of Florence (IT), University of Turin (IT), Medical University of Vienna (AT), Sapienza University of Rome (IT), University of Bologna (IT), KU Leuven (BE)
Bayer, Roche, European Commission, Università di Pisa
Openalex Percentile: Top 7%
Inflammatory Biomarkers in Disease Prognosis
DOIOpen Access PDFOpenAlex
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