Treatment, outcomes, and impact of racial disparities on young adults with pancreatic cancer.

e18069 Background: Pancreatic cancer is a disease of the elderly. The treatment and outcomes of young adults with pancreatic cancer has not been well studied. The aim of this study is to describe the treatment, outcomes, and impact of race in young adults with pancreatic cancer. Methods: Data were obtained from all US hospitals that contributed to the National Cancer Database (NCDB) between 2004 and 2013. Univariate and multivariate testing was done to identify factors associated with patient outcome. Kaplan-Meier analysis and Cox proportional hazards models were used to assess the association between patient characteristics, time intervals and survival. Results: A total of 9,657 patients between 18 and 50 years of age were identified. The mean age was 45.4 years (SD±4.6), with a male preponderance (58.3%). Distribution across stages I-IV was 6.1%, 31.1%, 13.9% and 48.8% consecutively, and was similar across all racial groups. About 30.9% of patients underwent resection of the primary pancreatic tumor. Univariate analysis showed survival difference between ages 18-34 vs. 35-50 years old (HR 0.81; 0.71-0.92; p<0.001). On multivariable analysis, Hispanics had significantly higher survival rates than non-Hispanic Whites (NHW) (HR 0.7; 0.64-0.76; p<0.001). Compared to Blacks, Hispanics were more likely to benefit from surgical resection (HR 0.76; 0.61-0.94; p=0.011) and chemotherapy administration (HR 0.78; 0.69-0.88; p<0.001). Overall, patients treated between 2009 and 2013 had higher survival rates compared to 2004-2008 (HR 0.86; 0.82-0.91; p<0.001). The improvement in 5-year overall survival rates over time was highest in American Indians and Asian/Pacific Islanders (16.6% vs. 6.5%); Blacks (10.6% vs. 8.5%) and Hispanics (14.5% vs. 12.6%). NHWs marginally improved from 8.4% to 9.8%. Conclusions: Survival in pancreatic cancer patients younger than 50 years has improved over time, with major gains in minority populations. [Table: see text]

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Prognostic value of serum interleukin-6 and YKL-40 and systemic inflammatory response in patients with unresectable pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.267 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 267-267

Author(s):

Inna Chen ◽

Christian Dehlendorff ◽

Benny Vittrup Jensen ◽

Per Pfeiffer ◽

Jon K. Bjerregaard ◽

...

Keyword(s):

Pancreatic Cancer ◽

Inflammatory Response ◽

Interleukin 6 ◽

Prognostic Value ◽

Univariate Analysis ◽

White Blood Cells ◽

Multivariable Analysis ◽

Laboratory Data ◽

Cox Proportional Hazards ◽

Systemic Inflammatory Response

267 Background: Interleukin-6 (IL-6) and YKL-40 (CHI3L1) are produced by pancreatic cancer (PC) cells and macrophages and activate inflammation. The aim of this prospective-retrospective biomarker study was to determine the prognostic value of serum IL-6 and YKL-40 and systemic inflammatory response in patients with PC receiving palliative chemotherapy. Methods: 625 patients with PC (M/F: 283/342; age <70 vs. ≥70: 395/230; ECOG PS of 0/1/2/3: 214/315/92/4; stage 3 vs. 4: 129/496; treated with gemcitabine n=437, FOLFIRINOX n=117, gemcitabine and nab-Paclitaxel n=54 or other n=17) were included in the BIOPAC biomarker study from 5 hospitals in Denmark. Pretreatment serum values of IL-6 (R&D Systems), YKL-40 (Quidel), and CA 19-9 (Siemens) were determined. Patients were grouped as low vs. high, dichotomized using cut-off for IL-6 > 4.92 pg/ml, for CA19-9 > 2183 U/ml and for YKL-40 > 95% age-corrected percentile. The main outcome was overall survival (OS) and hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were computed using Cox proportional hazards regression. Results: 598 (95.7%) patients died during follow-up. In univariate analysis elevated IL-6 (HR 1.93, 95% CI 1.63-2.28) and elevated YKL-40 (HR 1.74, 95% CI 1.47-2.05) were associated with short OS. Similar results were found if IL-6 and YKL-40 were included as continuous log2-transformed variables. Multivariable analysis showed that elevated IL-6 (HR 1.61, 95% CI 1.33-1.94), elevated YKL-40 (HR 1.36, 95% CI 1.13-1.64), elevated CA19-9 (HR 1.30, 95% CI 1.09-1.56), higher PS (1 vs. 0; HR 1.46, 95% CI 1.21-1.77 and PS 2 vs. 0; HR 2.73, 95% CI 2.08-3.58) and stage 4 vs. 3 (HR 1.79, 95% CI 1.44-2.24) were independently associated with a poor OS. In a subgroup of 386 patients with available laboratory data, higher C-reactive protein (HR 1.20, 95% CI 1.13-1.26), white blood cells (HR 1.41, 1.17-1.71) and absolute neutrophils count (HR 1.35, 95% CI 1.15-1.59) log2-transformed and adjusted for age, sex, PS, CA 19-9 and stage were associated with short OS. Conclusions: Serum IL-6, YKL-40 and CA19-9 along with CRP, WBC and ANC are independent prognostic biomarkers in patients with unresectable PC.

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Disparity in outcomes of melanoma adjuvant immunotherapy by demographic profile

Melanoma Management ◽

10.2217/mmt-2020-0002 ◽

2020 ◽

Vol 7 (2) ◽

pp. MMT43

Author(s):

Alexandra Ikeguchi ◽

Michael Machiorlatti ◽

Sara K Vesely

Keyword(s):

Survival Benefit ◽

Proportional Hazards ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Demographic Factors ◽

Cox Proportional Hazards ◽

Adjuvant Immunotherapy ◽

Node Positive ◽

Melanoma Patients ◽

The Impact

Background: Randomized comparisons have demonstrated survival benefit of adjuvant immunotherapy in node-positive melanoma patients but have limited power to determine if this benefit persists across various demographic factors. Materials & methods: We assessed the impact of demographic factors on the survival benefit of adjuvant immunotherapy in a database of 38,189 node-positive melanoma patients using the Kaplan–Meier method and Cox proportional hazards models. Results: All assessed demographic factors other than race significantly impacted survival of node-positive melanoma patients in univariate analysis. In multivariable analysis, only the age group interacted with immunotherapy. Conclusion: Analysis of this large database of unselected node-positive melanoma patients demonstrated a positive survival benefit of immunotherapy across all demographic factors assessed and the impact was greater for patients 65 years of age and older.

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Autoantibodies are not Predictive Markers for the Development of Depressive Symptoms in a Population-Based Cohort of Older Adults

European Psychiatry ◽

10.1016/j.eurpsy.2015.06.006 ◽

2015 ◽

Vol 30 (6) ◽

pp. 694-700 ◽

Cited By ~ 2

Author(s):

R.A. Iseme ◽

M. McEvoy ◽

B. Kelly ◽

L. Agnew ◽

J. Attia ◽

...

Keyword(s):

Symptom Score ◽

Depressive Disorders ◽

Tissue Transglutaminase ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Nuclear Antigen ◽

Thyroid Peroxidase ◽

Depression Symptom ◽

Healthy Elderly ◽

Over Time

AbstractBackgroundAutoantibodies have been implicated in the etiologic pathway of depressive disorders. Here, we determine the association between the presence of a panel of autoantibodies at baseline and change in depression symptom score over 5-year follow-up in a cohort of healthy elderly Australians.MethodsSerum samples from 2049 randomly selected subjects enrolled in the Hunter Community Study (HCS) aged 55–85 years were assayed for a range of autoimmune markers (anti-nuclear autoantibodies, extractable nuclear antigen autoantibodies, anti-neutrophil cytoplasmic autoantibodies, thyroid peroxidase autoantibodies, tissue transglutaminase autoantibodies, anti-cardiolipin autoantibodies, rheumatoid factor and cyclic citrullinated peptide autoantibodies) at baseline. Depression symptom score was assessed using the Centre for Epidemiological Study (CES-D) scale at baseline and 5 years later.ResultsAutoantibody prevalence varied amongst our sample with ANA being the most prevalent; positive in 16% and borderline in 36% of study population. No evidence for a relationship was found between change in CES-D score over time and any autoimmune marker. Statins and high cholesterol were significantly associated with change in CES-D score over time in univariate analysis; however, these were probably confounded since they failed to remain significant following multivariable analysis.ConclusionsAutoantibodies were not associated with change in CES-D score over time. These findings point to an absence of autoimmune mechanisms in the general population or in moderate cases of depression.

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Application of a time-varying covariate model to the analysis of CA 19–9 as a biomarker for time-to-progression (TTP) and overall survival (OS) in patients with advanced pancreatic cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e15545 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e15545-e15545

Author(s):

S. Boeck ◽

R. P. Laubender ◽

M. Haas ◽

C. Klose ◽

F. Kullmann ◽

...

Keyword(s):

Pancreatic Cancer ◽

Proportional Hazards ◽

Univariate Analysis ◽

Locally Advanced ◽

Predictive Biomarker ◽

Cox Proportional Hazards ◽

Time Varying ◽

Cox Proportional Hazards Regression ◽

Proportional Hazards Regression ◽

Pre Treatment

e15545 Background: It remains unclear whether baseline CA 19–9 or CA 19–9 kinetics during chemotherapy may serve as predictive biomarker in patients (pts) with pancreatic cancer (PC). Methods: Main inclusion criteria for this retrospective multicenter analysis: histologically confirmed diagnosis of PC, treatment with first-line therapy, pre-treatment CA 19–9 level of > 5.2 U/ml. Analysis of CA 19–9 was exclusively performed using the Elecsys® assay (Roche Diagnostics). The effect of the pre- treatment CA 19–9 level on TTP and OS was modelled by Cox proportional hazards regression. The effect of CA 19–9 kinetics was also modelled by Cox proportional hazards regression where CA 19–9 was treated as time-varying covariate. When modelling CA 19–9 we developed univariate and multivariate Cox models where we selected additional predictors (e.g. performance status) using backward elimination performing likelihood ratio tests on a significance level of 0.05. Results: One-hundred and fifteen pts from 5 German centers were included. Median age was 63 years, 12% had locally advanced and 88% metastatic disease; 73 % of the pts were treated within prospective clinical trials. Median baseline CA 19–9 was 1059 U/ml (range 9.5–100000), median pre- treatment bilirubin 0.6 mg/dl. The median TTP in the study population was 4.4 months, median OS 9.4 months. Univariate analysis showed that the pre-treatment CA 19–9 level (as continuous variable, log [CA 19–9]) was significantly associated with TTP (HR 1.24, 95% CI 1.12–1.37, p<0.001) and OS (HR 1.16, 95% CI 1.06–1.28, p=0.002). These associations remained significant also within a multivariate analysis. For CA 19–9 kinetics during chemotherapy, data from 69 pts (TTP) and 84 pts (OS) were available, respectively; log [CA 19–9] kinetics were found to be a significant predictor for TTP in univariate (HR 1.44, 95% CI 1.25–1.67, p<0.001) and multivariate (HR 1.39, 95% CI 1.19–1.62, p<0.001) analyses, and also for OS (univariate: HR 1.34, 95% CI 1.20–1.49, p<0.001; multivariate: HR 1.39, 95% CI 1.23–1.57, p<0.001). Conclusions: According to this new statistical model, CA 19–9 may serve as a useful predictive biomarker in advanced PC. [Table: see text]

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Impact of M1a and M1b staging in patients (pts) with metastatic colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.3590 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 3590-3590 ◽

Cited By ~ 1

Author(s):

Hagen F. Kennecke ◽

Jason Yu ◽

Sharlene Gill ◽

Winson Y. Cheung ◽

Charles Davic Blanke ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Primary Tumor ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Cox Proportional Hazards ◽

Prognostic Impact ◽

Primary Tumors ◽

7Th Edition ◽

The Impact

3590 Background: In 2009, pts with M1 colorectal cancer were divided into two subsets for the American Joint Committee on Cancer (AJCC) 7th edition. Pts with metastases (mets) confined to one organ or site at initial diagnosis became stage M1a while multiple sites or peritoneal mets became M1b. The objectives of the study are to evaluate the impact of site of mets and M1a/b staging among pts with M1 colorectal cancer. Methods: All pts referred to the BC Cancer Agency from 1999-2007 with newly diagnosed M1 colon or rectal cancer were included. Demographic, treatment, and outcome data were prospectively collected. The prognostic impact of individual sites of mets was assessed by hazard ratio estimates from univariate Cox models. Multivariable Cox proportional-hazards models were used to determine variables associated with overall survival in the entire cohort and in those undergoing resection of their primary tumor. Results: 2,049 pts with M1 disease were included. Median age was 66 years; 71% had colonic origin; 70% had their primary tumor resected; and 69% received chemotherapy. In univariate analysis, solitary mets were associated with improved survival. In multivariable analysis, M1a/b status still had significant prognostic effect. The effect remained significant in the subgroup analysis of pts with resected primary tumors when histology, T and N stage were included. Conclusions: Pts with solitary mets, including peritoneum, have superior overall survival as compared to those with multiple sites of mets. AJCC 7th edition staging that includes M1a/b provides significant prognostic information and should be considered in clinical practice and trials of pts with M1 disease who otherwise have few prognostic factors. [Table: see text]

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Pre-treatment neutrophil to lymphocyte ratio (NLR) association with curative intent metastasectomy (MSX) in metastatic renal cell carcinoma (RCC).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e16051 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e16051-e16051

Author(s):

Aline Fusco Fares ◽

Daniel Vilarim Araujo ◽

Eliza Dalsasso Ricardo ◽

Marcelo Corassa ◽

Maria Nirvana Cruz Formiga ◽

...

Keyword(s):

Proportional Hazards ◽

Univariate Analysis ◽

Prognostic Significance ◽

Multivariable Analysis ◽

Regression Tree ◽

Positive Association ◽

Cox Proportional Hazards ◽

Curative Intent ◽

Risk Of Death ◽

Metastatic Rcc

e16051 Background: NLR is a marker of inflammation and when elevated is associated with poor outcome in many tumors, including RCC. Hereby we evaluate the association of NLR with the likelihood of curative intent MSX. Methods: We retrospectively studied 846 patients diagnosed with metastatic RCC between 2007 and 2016. 116 patients fulfilled inclusion criteria: previous nephrectomy, no sarcomatoid features and available tumor specimens from metastatic site. Regression tree for censored data method was used to find the best NLR cut-off value. NLR was examined baseline – prior to MSX or targeted therapy. Chi-square test was used to evaluate associations between variables. We estimated overall survival (OS) using Kaplan-Meier curves. Cox proportional hazards regression models were fitted to evaluate the prognostic significance of NLR in univariable and multivariable analysis. Results: The median OS for the whole cohort was 45 months (95% CI, 27.6 to 62.4 months), and the median follow-up was 78.2 months. The best cut-off NLR value was 4.07. Higher NLR was associated with shorter OS when compared to the lower NLR cohort (11.5 months vs 68.3 months HR = 0.26, 95% CI: 0.15 – 0.97, p ≤ 0.0001, respectively). Univariate analysis revealed that bone metastasis and poor IMDC criteria were associated with worse OS and that MSX and lower NLR were associated with better OS. On multivariate analysis MSX, lower NLR and favourable/intermediate group on IMDC criteria were associated with a decreased risk of death (HR = 0.41, 95% CI 0.19-0.85, p = 0.018 and HR = 0.45, 95% CI 0.22-0.90, p = 0.025, HR = 0.35, 95% CI 0.16-0.79, p = 0.012, respectively). We found a positive association of lower NLR and curative intent MSX (p = 0.002). Conclusions: NLR is a prognostic marker in metastatic RCC and a ratio ≤ 4,07 is associated with a higher likelihood of curative intent MSX.

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Utilization and outcomes of surgical castration in comparison to medical castration in metastatic prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.288 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 288-288

Author(s):

Rohan Garje ◽

Adithya Chennamadhavuni ◽

Sarah L Mott ◽

Isaac Matthew Chambers ◽

Paul Gellhaus ◽

...

Keyword(s):

Prostate Cancer ◽

Metastatic Prostate Cancer ◽

Cox Regression ◽

Private Insurance ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Survival Difference ◽

Caucasian Race ◽

Effect Of Treatment ◽

Care Costs

288 Background: Androgen deprivation therapy (ADT) is the gold standard for metastatic prostate cancer (mPC) which can be achieved either by surgical or medical castration (SC, MC). In this study we evaluate the trends of utilization of SC and also assess survival difference compared to MC. Methods: National Cancer Database was used to identify patients with mPC from 2004 to 2014. Logistic and Cox regression models were utilized to estimate the odds of utilization of SC and effect of treatment on overall survival (OS). Results: A total of 33712 pts with mPC were identified; 31722 (94.1%) had MC and 1990 (5.9%) underwent SC. There was significant decline in the trend of utilization of SC from 8.5% in 2004 to 3.1% in 2014. On multivariable analysis, being a non-caucasian race, lower household income levels, having non-private insurance and earlier years of Dx were found to be associated with increased odds of choosing SC over MC. Notably, the odds of SC were lower at academic centers. On univariate analysis, a survival difference between ADTs was evidenced (p<0.01); 5-yr OS for MC and SC was 24.8% and 18.2%. However, on multivariate analysis there was no OS difference between SC and MC (p=0.14). Conclusions: In this large contemporary analysis, the utilization of SC has declined overtime with no OS difference when compared to MC. With rising health care costs, changing the practice by utilizing SC can help reduce healthcare expenditure. [Table: see text]

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Trends in survival based on treatment modality in patients with pancreatic cancer: a population-based study

Current Oncology ◽

10.3747/co.27.5211 ◽

2020 ◽

Vol 27 (1) ◽

Cited By ~ 1

Author(s):

S. Shakeel ◽

C. Finley ◽

G. Akhtar-Danesh ◽

H. Y. Seow ◽

N. Akhtar-Danesh

Keyword(s):

Pancreatic Cancer ◽

Treatment Modality ◽

Survival Rates ◽

Population Based ◽

Parametric Models ◽

Stage I ◽

Analysis Survival ◽

Long Term Prognosis ◽

Over Time

Background Pancreatic cancer (PC) is one of the most lethal types of cancer and surgery remains the most optimal treatment modality for patients with resectable tumors. The objective of this study is to examine and compare the trends in survival rate among PC patients based on treatment modality.Methods This population-based retrospective analysis included all patients with known stage for PC in Ontario, Canada between 2007 and 2015. Flexible parametric models were used to conduct survival analysis. Survival rates were calculated based on treatment modality, while adjusting for patient and tumor specific covariates.Results In total, 6437 patients were included in this study. More than half of the patients aged 80 and over received no curative treatment. The proportion of patients receiving chemoradiation decreased over time. The 1-, 2- and 5-year survival rates increased 30-40% for stage I disease and less than 15% for stage II over the study period. Noticeable increases in 1-, 2, and 5-year survival rates were observed for patients underwent for distal pancreatectomy and Whipple procedures. There were no changes in survival for stage III and IV disease from 2007 to 2015.Conclusions A majority of cases for PC continue to be diagnosed in late stage, with poor short-term and long-term prognosis. The survival for stage I tumors and surgical modalities increased over time without any evidence of changes in stage distribution. We speculate that improvements in chemotherapy modalities and adoption of quality standards for surgical resection could be attributed for the positive trends in survival.

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Association between skin toxicities and treatment outcomes in patients with pancreatic cancer (PC) receiving erlotinib (E): Memorial Sloan-Kettering Cancer Center (MSKCC) experience.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.294 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 294-294 ◽

Cited By ~ 1

Author(s):

Linh My Alejandro ◽

Nelly G. Adel ◽

Eileen Mary O'Reilly ◽

Elyn Riedel ◽

Mario E. Lacouture

Keyword(s):

Pancreatic Cancer ◽

Skin Rash ◽

Proportional Hazards Model ◽

Univariate Analysis ◽

Medical Intervention ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Patient Comfort ◽

Smoking History ◽

Cancer Center

294 Background: Rash is a common adverse event of E, an epidermal growth factor receptor (EGFR) inhibitor approved for advanced PC. Clinical trial results have shown that E-related rash grade 2 or higher is associated with a survival benefit in PC. We examined the correlation between all grades of rash and overall survival (OS) in PC patients receiving E at MSKCC. Methods: This was a retrospective single-institution study that included a review of all PC patients treated with E between March 1st 2005 and December 15th 2009 at MSKCC. The association of development of rash on OS was examined using a Cox proportional hazards model using development of rash as a time dependent covariate. The associations were examined univariately and after adjusting for gender, race, smoking history, prior lines of treatment for metastatic disease, and chemotherapy. An intervention was defined as a dose change, interruption, discontinuation or medical intervention for rash. Results: N=193 constituted the cohort of analysis. The median age was 64; 116 (60%) were male and 162 (84%) were Caucasian. Most patients (N=111, 58%) did not receive any prior medical treatment for pancreatic cancer. Skin rash occurred in 113 (59%) of patients. The median OS was 6.7 months (95% confidence interval, 5.7-7.9 months). In a univariate analysis, rash was protective compared to no skin rash (Grade 1 HR 0.71; 95% CI 0.50-1.00, Grade 2+ HR 0.57; 95% CI 0.40-0.82; P=0.007). In the multivariate model, rash appeared to have a protective effect on survival, but this was not statistically significant (Grade 1 HR 0.69; 95% CI 0.49-0.97, Grade 2+ HR 0.78; 95% CI 0.48-1.27). Non-medical interventions for rash included dose adjustment (5%), dose interruption (6%) and dose discontinuation (9%). 33 (29%) patients received medical intervention for rash. Conclusions: Our findings suggest that grade 1 or higher E-related rash may be a surrogate for survival. Appropriate symptom interventions are recommended to enhance patient comfort and avoid discontinuation of treatment.

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The neutrophil to lymphocyte ratio as a prognostic factor among a diverse population with advanced pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e15729 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e15729-e15729

Author(s):

Michael Shusterman ◽

Erin Jou ◽

Andreas Kaubisch ◽

Jennifer W. Chuy ◽

Lakshmi Rajdev ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Metastatic Disease ◽

Proportional Hazards ◽

Univariate Analysis ◽

Prognostic Significance ◽

Advanced Pancreatic Cancer ◽

Cox Proportional Hazards ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio

e15729 Background: The neutrophil to lymphocyte ratio (NLR), a marker of systemic inflammatory response, has been suggested as a prognostic marker in patients with pancreatic adenocarcinoma (PAC). Black and Hispanic patients have been underrepresented in studies evaluating the significance of NLR in PAC. We investigated the prognostic significance of NLR in patients with advanced PAC treated at the Montefiore-Einstein Center for Cancer Care (MECCC) in the Bronx, NY. Methods: We included patients who were chemotherapy naive and treated for unresectable or metastatic PAC at MECCC between 2006 and 2015. Demographics, clinical characteristics and treatment data were collected. Overall survival was determined by the Kaplan-Meier method and Cox proportional-hazards models were built to assess survival differences adjusting for clinically relevant and statistically significant variables. Results: 201 patients were included in the study. Median age was 65 (range 32, 90). 52% were male. 41 were White (19%), 71 Black (33%), 71 Hispanic (33%), and 33 Other (15.3%). 66 (30.6%) had unresectable disease and 135 (62.5%) metastatic disease. An NLR ≥ 4 was associated with a worse OS compared to an NLR ≤ 4 (median 10 vs. 16.4 months; HR 1.895; 95% CI 1.390, 2.585; P < 0.0001). Predictors of worse OS on univariate analysis were ever smoker status (HR 1.365; P = 0.05), metastatic disease (HR 1.736; P = 0.001), and albumin ≤ 3.5 g/dL (HR 2.558; P< 0.0001). An NLR ≥ 4 on multivariate analysis remained significantly associated with worse OS (HR 1.665; 95% CI 1.188, 2.334; P = 0.003) after adjusting for age, gender, ever smoker status, metastatic disease, and albumin. Conclusions: In a cohort with significant minority patient representation, an NLR ≥ 4 was associated with significantly worse overall survival in patients with advanced pancreatic cancer. An elevated NLR in advanced PAC may be an important independent predictor to risk stratify patients and predict poor OS in future analyses.

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