Neutrophil-to-lymphocyte Ratio is a Predictive Marker for Invasive Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas

Gemenetzis, Georgios; Bagante, Fabio; Griffin, James F.; Rezaee, Neda; Javed, Ammar A.; Manos, Lindsey; Lennon, Anne Marie; Wood, Laura D.; Hruban, Ralph H.; Li, Zheng; Zaheer, Atif; Fishman, Elliot K.; Ahuja, Nita; Cameron, John L.; Weiss, Matthew J.; He, Jin; Wolfgang, Christopher L.

doi:10.1097/sla.0000000000001988

Cited by 101 publications

(100 citation statements)

References 48 publications

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“…Absolute peripheral blood neutrophil count more than 8.0 × 10 9 /L was considered as neutrophilia, and absolute peripheral blood lymphocyte count was less than 1.0 × 10 9 /L as lymphocytopenia. In addition, the number of platelets in the blood more than 400 × 10 9 /L was considered as thrombocytosis …”

Section: Methodsmentioning

confidence: 99%

“…Neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) are routinely used and convenient inflammatory markers that reflect this immune response, and have been demonstrated to be prognostic for several malignancies including pancreatic Carcinoma . Recently, both markers have also been shown associated with prognosis in pancreatic cystic neoplasms (PCNs) . However, the association between systemic inflammatory markers and biological behavior of SPTP has not been studied.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative neutrophil‐to‐lymphocyte ratio predicts malignancy and recurrence‐free survival of solid pseudopapillary tumor of the pancreas

Yang

Bao

Zhou

et al. 2019

Journal of Surgical Oncology

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Background Systemic inflammatory markers such as neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) have been shown to be prognostic for many types of pancreatic malignancy. The aim of this study was to evaluate the prognostic role of these markers in patients with solid pseudopapillary tumor of the pancreas (SPTP). Methods Patients who underwent surgical resection for histologically confirmed SPTP were retrospectively reviewed in our institution. Preoperative NLR and PLR were calculated. Clinicopathologic data were correlated with the presence of malignant potential and recurrence‐free survival (RFS). Results A total of 113 patients with SPTP were included in this study. Of them, 23 were men and 90 were women, with a median age of 35 years (interquartile range, 25‐44). The optimal cut‐off values for malignant SPTP were 3.22 for NLR, and 75.5 for PLR, respectively. Univariate analysis showed that high NLR (>3.22) and white blood cell count more than 9.96 × 109/L were predictive of a malignant SPTP. Meanwhile, high NLR (P = 0.001) and age more than 35 years (P = 0.026) were associated with worse RFS. On multivariable analyses, high NLR was the only independent predictor of malignant SPTP (odd ratio 6.871; 95% confidence interval [CI], 1.482‐31.864; P = 0.014) and RFS (hazard ratio 12.633; 95% CI, 1.758‐90.790; P = 0.012). Conclusions This study highlights the supportive role of preoperative NLR in predicting malignancy and RFS of SPTP patients. Further studies including a larger cohort of patients are needed to corroborate our findings.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preoperative neutrophil‐to‐lymphocyte ratio predicts malignancy and recurrence‐free survival of solid pseudopapillary tumor of the pancreas

Yang

Bao

Zhou

et al. 2019

Journal of Surgical Oncology

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“…Investigators from our Institution have reported an association between tumorassociated neutrophils (TANs) and advanced IPMN lesions (78). The recent publication of Gemenetzis et al (79) evaluating the correlation between NLR and platelet-tolymphocyte ratio (PLR) values and the presence of invasive carcinoma in patients with IPMN. Despite the limitations of the study that the authors acknowledge, including its retrospective nature and the non-specificity of the results since blood is a complex fluid with high cellular turnover, the striking finding was that NLR was significantly elevated in patients with IPMN-associated invasive carcinoma in a value higher than 4 (79).…”

Section: Peripheral Blood Cellmentioning

confidence: 99%

Updates and Critical Evaluation on Novel Biomarkers for the Malignant Progression of Intraductal Papillary Mucinous Neoplasms of the Pancreas

Moris

Damaskos

Spartalis

et al. 2017

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“…More recently, the neutrophil-to-lymphocyte ratio (NLR) in blood has been evaluated as a novel predictor of HGD and invasive carcinoma, which could presumably reflect the systemic immune response elicited by cancer, among other potential physiologic mechanisms [38,39]. In a series of 272 patients with resected IPMN from the Johns Hopkins Hospital, Gemenetzis et al [39] found that an NLR > 4 was significantly associated with invasive carcinoma, independent of MPD size, presence of mural nodules, jaundice, and cyst size.…”

Section: Circulating Biomarkers For Prediction Of High-risk Intraductmentioning

confidence: 99%

“…In a series of 272 patients with resected IPMN from the Johns Hopkins Hospital, Gemenetzis et al [39] found that an NLR > 4 was significantly associated with invasive carcinoma, independent of MPD size, presence of mural nodules, jaundice, and cyst size. Notably, a higher NLR was not associated with HGD without invasive carcinoma.…”

Section: Circulating Biomarkers For Prediction Of High-risk Intraductmentioning

confidence: 99%

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Strategic Considerations

et al. 2017

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Intraductal papillary mucinous neoplasms (IPMN) are cystic neoplasms with the potential for progression to pancreatic cancer. Recognized by the global medical community just over two decades ago, IPMN have gained great epidemiological and clinical relevance thanks to the widespread use of cross-sectional abdominal imaging, which has led to a surge in the number of incidental pancreatic cysts being diagnosed. As our understanding of this disease has improved, we now know that some IPMN have a very elevated risk of cancer and require surgical resection, while others are low-risk lesions and can be followed. The approach to IPMN must therefore strike a balance between preventing the over-utilization of surgery and the timely recognition and treatment of patients with high-risk lesions. Several clinical, radiographic, and laboratory parameters have been proposed to risk-stratify IPMN, leading to the publication of management guidelines that do not always converge in their recommendations. The goal of this clinical therapeutic review is to describe the strategic approach to IPMN at the Massachusetts General Hospital, and how our current understanding, management algorithm, and future directions have been informed by research efforts at our institution and other centers.

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Neutrophil-to-lymphocyte Ratio is a Predictive Marker for Invasive Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas

Abstract: NLR is an independent predictive marker for the presence of IPMN-associated invasive carcinoma. Further prospective studies are needed to assess the predictive ability of NLR and how it can be applied in the clinical setting.

Cited by 101 publications

References 48 publications

Preoperative neutrophil‐to‐lymphocyte ratio predicts malignancy and recurrence‐free survival of solid pseudopapillary tumor of the pancreas

Preoperative neutrophil‐to‐lymphocyte ratio predicts malignancy and recurrence‐free survival of solid pseudopapillary tumor of the pancreas

Updates and Critical Evaluation on Novel Biomarkers for the Malignant Progression of Intraductal Papillary Mucinous Neoplasms of the Pancreas

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Strategic Considerations

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