The value of systemic inflammatory markers in identifying malignancy in mucinous pancreatic cystic neoplasms

Abstract

The treatment decision-making of mucinous pancreatic cystic neoplasm (PCN) has become a common clinical problem since the diagnostic accuracy of current tests in identifying malignancies in pancreatic cysts is limited. In this study, we aimed to validate the predictive value of systemic inflammatory factors in detecting malignant PCNs. Two hundred and forty-five patients with pathologically confirmed mucinous PCNs in a single Chinese institution were retrospectively analyzed. Receiver operating characteristic (ROC) curves were calculated to determine the optimal cut-off values and measure the diagnostic value. The results showed that neutrophil count (P = 0.009), lymphocyte count (P = 0.002), neutrophil-to-lymphocyte ratio (NLR, P < 0.001), platelet-to-lymphocyte ratio (PLR, P < 0.001) and lymphocyte-to-monocyte ratio (LMR, P < 0.001) were distributed differently among the various differentiation groups of PCN. The univariate analyses indicated that a neutrophil count ≥ 2.8 × 109/L (P = 0.024), lymphocyte count ≤ 1.9 × 109/L (P < 0.001), PLR ≥ 125 (P < 0.001), NLR ≥ 1.96 (P < 0.001), and LMR ≤ 4.29 (P < 0.001) were significantly associated with invasive carcinomas in PCN patients. In addition, the multivariate analyses demonstrated that PLR ≥ 125 and LMR ≤ 4.29 were independent predictors of invasive malignancies. The ROC curves exhibited the malignant detection utility of the independent factor-based predictive model with an area under the curve (AUC) of 0.858 (P < 0.001). In conclusion, systemic inflammatory markers provide a supportive and easily accessible tool for the preoperative diagnoses of malignant PCNs.

The Value of Serum Tumor Markers and Blood Inflammation Markers in Differentiating Pancreatic Serous Cystic Neoplasms and Pancreatic Mucinous Cystic Neoplasms

“…Some inflammatory indicators (NLR, PLR, and LMR) based on circulating blood cells can be used as a simple and convenient way to measure systemic inflammatory response and as an independent predictor of survival and prognosis in various malignant tumors, including pancreatic cancer (8)(9)(10). Recently, there has been much evidence that inflammatory indicators also play an important role in predicting benign and malignant PCNs (12,13,31). Our study discovered that LA had good discrimination efficiency between SCNs and MCNs with an AUC of 0.6765 and a diagnostic cutoff point of 65.45.…”

Neutrophil-to-Lymphocyte Ratio as a Predictor of Invasive Carcinoma in Patients With Intraductal Papillary Mucinous Neoplasms of the Pancreas

“…14 Two additional studies demonstrated that NLR was predictive of invasive carcinoma on univariate analysis in all mucinous pancreatic cystic neoplasms. 16,17 Because NLR was elevated in patients with invasive disease, we further evaluated NLR for its association with pathologic factors that separate the more indolent colloid carcinoma from the more aggressive tubular subtype. Our results did not show that NLR was able to differentiate between the colloid and tubular subtypes, nor was it associated with any other pathologic variables.…”

“…[11][12][13] Studies have investigated the use of NLR as a biomarker in pancreatic cystic neoplasms, and previous data have suggested that NLR is predictive of invasive disease in patients with mucinous pancreatic cysts, including IPMN. [14][15][16][17] In this study, we sought to determine whether NLR was predictive of grade of dysplasia and invasive carcinoma in our cohort of patients who have undergone resection for IPMN. Additionally, we investigated whether NLR can preoperatively predict high-risk versus lowrisk lesions, and therefore, possibly help identify which patients should undergo surgical resection.…”

Systemic Inflammatory Response in Pancreatic Ductal Adenocarcinoma

“…SIR parameters have been proposed as markers of malignancy in pancreatic cystic neoplasms. Thus, in 245 patients with mucinous cystic pancreatic neoplasms, NLR ≥ 1.96 was significantly (p < 0.001) associated with invasive carcinoma [47]. In 318 surgically treated patients with pancreatic cystic neoplasms, high NLR was significantly associated with malignant tumour by univariate analysis.…”

“…In mucinous cystic neoplasms, elevated PLR was shown to be significantly associated with presence of invasive carcinoma in 245 patients from Shanghai [47] and 318 patients from Singapore [48].…”