Preoperative platelet-to-lymphocyte ratio improves the performance of the international consensus guidelines in predicting malignant pancreatic cystic neoplasms

Abstract

This study aimed to determine if neutrophilto-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were predictive of malignancy in pancreatic cystic neoplasms (PCN) and if these improved the performance of the international consensus guidelines (ICG) in the initial triage of these patients. Methods: 318 patients with surgically-treated suspected PCN were retrospectively reviewed. Malignant neoplasms were defined as neoplasms harbouring invasive carcinoma. The optimal cutoff for NLR and PLR were determined by plotting the receiver operating characteristics (ROC) curves of NLR/PLR in predicting malignant PCN and utilizing the Youden index. Results: The optimal NLR and PLR cutoffs were determined to be 3.33 and 205, respectively. Univariate analyses demonstrated that symptomatic PCNs, obstructive jaundice, presence of solid component, dilatation of main pancreatic duct 10 mm, high NLR and high PLR were predictive of a malignant PCN. Multivariate analyses demonstrated that obstructive jaundice, presence of solid component, MPD 10 mm and high PLR but not NLR were independent predictors of a malignant PCN. A high PLR significantly predicted invasive carcinoma in patients classified within the ICG HR group. Comparison between the ROC curves of the ICG versus ICG plus PLR in predicting malignant PCN demonstrated a significant improvement in the accuracy of the ICG when PLR was included [AUC 0.784 (95% CI: 0.740e0.829) vs AUC 0.822 (95% CI: 0.772e0.872) (p = 0.0032)]. Conclusions: High PLR is an independent predictor of malignancy in PCN. The addition of PLR as a criterion to the ICG improved the accuracy of these guidelines in detecting invasive neoplasms.

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

“…Serum tumor markers such as CEA, CA19‐9, and CA125 were all within normal ranges in them, indicating no value of these markers in predicting malignant SPTP. Previous studies have assessed the prognostic role of NLR in patients with many types of pancreatic neoplasms, demonstrating that high NLR was an effective predictor of malignancy . Goh et al showed that high PLR but not NLR was an independent predictor of malignant PCNs.…”

“…Previous studies have assessed the prognostic role of NLR in patients with many types of pancreatic neoplasms, demonstrating that high NLR was an effective predictor of malignancy . Goh et al showed that high PLR but not NLR was an independent predictor of malignant PCNs. However, all SPTPs were defined as nonmalignant in their study, leaving the predictive value of inflammatory markers for malignant SPTP unclear.…”

“…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.…”

The role of pancreatic juice cytology in the diagnosis of pancreatic intraductal papillary mucinous neoplasm

“…In order to overcome the limitations of the current guidelines, many studies have investigated whether adding certain laboratory markers to imaging improves its diagnostic abilities. These markers include CA19-9, CEA, neutrophil/lymphocyte ratio and the platelets/lymphocytes ratio (21)(22)(23)(24). However, the role of PJC is yet to be confirmed.…”

Nomogram for the Prediction of High-Grade Dysplasia and Invasive Carcinoma in Patients With Intraductal Papillary Mucinous Neoplasms of the Pancreas Based on Variables of Noninvasive Examination

“…However, EUS is not available or convenient in a number of regions in China; thus, we aimed to propose a new nomogram model with a low rate of EUS performance. Moreover, some reports suggest that preoperative neutrophil-to-lymphocyte ratio (NLR) ( 14 ) and platelet-to-lymphocyte ratio (PLR) ( 15 ) are useful predictive biomarkers for malignant potential in patients with IPMNs or pancreatic cystic neoplasms. Thus, we intended to incorporate these biomarkers to a nomogram model and use them to optimize the existing models.…”