Are preoperative blood neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios useful in predicting malignancy in surgically-treated mucin-producing pancreatic cystic neoplasms?
BACKGROUND
The aim of this study was to determine if neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were predictive of malignancy in mucin-producing pancreatic cystic neoplasms (MpPCN).


METHODS
One hundred and twenty patients with MpPCN were retrospectively reviewed. Malignant neoplasms were defined as neoplasms harbouring invasive carcinoma or high grade dysplasia. A high NLR and PLR were defined as ≥2.551 and ≥208.1, respectively.


RESULTS
High NLR was significantly associated with symptomatic tumors, larger tumors, solid component, main-duct IPMN, and Sendai high risk category. High PLR was significantly associated with jaundice and Sendai high risk category. On univariate analyses, symptomatic tumors, jaundice, solid component, dilated pancreatic duct, and both a high NLR and PLR were significant predictors of malignant and invasive MpPCN. On multivariate analyses, solid component and dilated pancreatic duct were independent predictors of malignant and invasive MpPCN. PLR was an independent predictor for invasive MpPCN. When MpPCN were stratified by the Fukuoka and Sendai Guidelines, both a high NLR and PLR were significantly associated with malignant neoplasms within the high risk categories.


CONCLUSIONS
PLR is an independent predictor of invasive carcinoma. The addition of PLR as a criterion to the FCG and SCG significantly improved the predictive value of these guidelines in detecting invasive neoplasms.
Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
Brian K P
BK
Goh
Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
Damien M Y
DM
Tan
Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
Chung-Yip
CY
Chan
Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
Ser-Yee
SY
Lee
Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
Victor T W
VT
Lee
Department of Oncologic Imaging, National Cancer Centre, Singapore.
Choon-Hua
CH
Thng
Department of Radiology, Singapore General Hospital, Singapore.
Albert S C
AS
Low
Division of Medical Oncology, National Cancer Centre, Singapore.
David W M
DW
Tai
Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
Peng-Chung
PC
Cheow
Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
Pierce K H
PK
Chow
Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
London L P J
LL
Ooi
Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
Alexander Y F
AY
Chung
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008214:Lymphocytes / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000378:metabolism*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009504:Neutrophils / Q000378:metabolism / Q000473:pathology*; D010181:Pancreatic Cyst / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
D009077:Mucins
intraductal papillary mucinous neoplasms; mucinous cystic neoplasms; neutrophil-lymphocyte-ratio; pancreatic cystic neoplasms; platelet-lymphocyte-ratio