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 study
Year: 2026
Type: article
Study design: Observational Study
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.
Source: ESMO Gastrointestinal Oncology
Authors: H. Vandeputte, A. Casadei-Gardini, F. Peeters, M. Rimini, F. Nichetti, A. Saborowski, L. Antonuzzo, L. Passeri, T. Satake, C. Vivaldi, T. Pressiani, J. Lucchetti, J.W. Kim, O. Abidoye, S. Corallo, I.G. Rapposelli, S. Tamberi, F. Finkelmeier, G. Giordano, C. Pircher, H.J. Chon, C. Braconi, A. Qaisar, C. Pirrone, F. Castet, E. Tamburini, C. Yoo, A. Parisi, A. Lancianese, A. Diana, M. Scartozzi, G.W. Prager, A. Avallone, M. Schirripa, I.H. Kim, L. Perkhofer, E. Oneda, M. Verrico, N. Couto, J. Adeva, S.L. Chan, G.P. Spinelli, N. Personeni, I. Garajova, M.G. Rodriquenz, S. Leo, C.M. Alvim, R. Roque, G. Farinea, A. De Rosa, I. Lanzetta, R. Balsano, D. Lavacchi, S. Camera, M. Ikeda, M. Niger, G. Tesini, G. Tonini, M. Kang, T. Bekaii-Saab, L. Esposito, A. Boccaccino, M. Ferrara, F. Lo Prinzi, V. Himmelsbach, M. Landriscina, S.A. Djaballah, M. Persano, F. Salani, A. Vogel, S. Lonardi, L. Fornaro, L. Rimassa, J. Dekervel
Institutions: Universitair Ziekenhuis Leuven, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele, Fondazione IRCCS Istituto Nazionale dei Tumori, Medizinische Hochschule Hannover, Azienda Ospedaliero-Universitaria Careggi, University of Florence, National Cancer Center Hospital East, University of Pisa, Azienda Ospedaliera Universitaria Pisana, IRCCS Humanitas Research Hospital, Università Campus Bio-Medico, Campus Bio Medico University Hospital, Seoul National University, Seoul National University Bundang Hospital, Mayo Clinic, Mayo Clinic Hospital, University of Pavia, Policlinico San Matteo Fondazione, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Ospedale "Santa Maria delle Croci" di Ravenna, University of Bologna, University Hospital Frankfurt, University of Foggia, Ospedali Riuniti di Foggia, CHA University Bundang Medical Center, CHA University, Beatson West of Scotland Cancer Centre, University of Glasgow, Ospedale Policlinico San Martino, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institute of Oncology, Pia Fondazione di Culto e Religione Azienda Ospedaliera "Card. G. Panico", Asan Medical Center, University of Ulsan, Marche Polytechnic University, University of Cagliari, Medical University of Vienna, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Ospedale di Belcolle, Inje University, Inje University Haeundae Paik Hospital, Inje University Busan Paik Hospital, Universität Ulm, University Hospital Ulm, Fondazione Poliambulanza Istituto Ospedaliero, Policlinico Umberto I, Sapienza University of Rome, Centro Champalimaud, Hospital Universitario 12 De Octubre, Chinese University of Hong Kong, Prince of Wales Hospital, Azienda Socio Sanitaria Territoriale del Garda, Casa Sollievo della Sofferenza, Ospedale Vito Fazzi, Hospital de Santa Maria, Instituto Português de Oncologia de Coimbra Francisco Gentil, Ospedale San Luigi Gonzaga, University of Turin, University of Padua, Istituto Oncologico Veneto, Humanitas University, Toronto General Hospital, Princess Margaret Cancer Centre
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,170
Awards: G1033601615, G5924588071, G721431099
OpenAlex ID: W7160629596