Background: Studies have been carried out to highlight the connection between the Neutrophil–Lymphocyte Ratio (NLR) and the prognosis of pancreatic cancer, still with controversial findings. This study retrospectively examined the relation between NLR and response to treatment, time to treatment failure (TTF), and overall survival (OS) among patients with advanced pancreatic cancer.

Subjects and methods: This observational retrospective cohort study was carried out on 80 patients diagnosed with advanced pancreatic cancer treated with first-line chemotherapy. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. We evaluated the TTF and OS in all cases.

Results: Using the 1-year survival as a time point to create the receiver operating characteristics (ROC) curve, the optimal cut-off value for baseline NLR was found to be 2.05 with an area under the curve (AUC) of 0.906. Patients with NLR ≤2.05 revealed a significantly longer OS (mean: 11.347 months) than patients with NLR >2.05 (mean: 6.707 months) with a significant p-value of <0.001. NLR had a sensitivity of 81.2% and specificity of 84.4% at a threshold value of 2.05 in predicting mortality. For patients with NLR ≤2.05, the average TTF was longer (7.075 months) compared with those with NLR >2.05 (6.670 months) but with no significant difference (P >0.05).

Conclusion: NLR could serve as a valuable prognostic and predictive biomarker in advanced pancreatic cancer, aiding treatment decision-making and patient management.