title: Neutrophil-to-lymphocyte Ratio is a Predictive Marker for Invasive Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas.
abstract: To evaluate the correlation between neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) values, and the presence of invasive carcinoma in patients with intraductal papillary mucinous neoplasm (IPMN).
  
  
  
  NLR and (PLR) are inflammatory markers that have been associated with overall survival in patients with invasive malignancies, including pancreatic cancer.
  
  
  
  We retrospectively reviewed 272 patients who underwent surgical resection for histologically confirmed IPMN from January 1997 to July 2015. NLR and PLR were calculated and coevaluated with additional demographic, clinical, and imaging data for possible correlation with IPMN-associated carcinoma in the form of a predictive nomogram.
  
  
  
  NLR and PLR were significantly elevated in patients with IPMN-associated invasive carcinoma (P < 0.001). In the multivariate analysis, NLR value higher than 4 (P < 0.001), IPMN cyst of size more than 3 cm (P < 0.001), presence of enhanced solid component (P = 0.014), main pancreatic duct dilatation of more than 5 mm (P < 0.001), and jaundice (P < 0.001) were statistically significant variables. The developed statistical model has a c-index of 0.895. Implementation of the statistically significant variables in a predictive nomogram provided a reliable point system for estimating the presence of IPMN-associated invasive carcinoma.
  
  
  
  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.
authors.affiliation: *Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD †Department of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD ‡Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD §Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD ¶Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gemenetzis
authors.forename: Fabio
authors.initials: F
authors.lastname: Bagante
authors.forename: James F
authors.initials: JF
authors.lastname: Griffin
authors.forename: Neda
authors.initials: N
authors.lastname: Rezaee
authors.forename: Ammar A
authors.initials: AA
authors.lastname: Javed
authors.forename: Lindsey L
authors.initials: LL
authors.lastname: Manos
authors.forename: Anne M
authors.initials: AM
authors.lastname: Lennon
authors.forename: Laura D
authors.initials: LD
authors.lastname: Wood
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
authors.forename: Lei
authors.initials: L
authors.lastname: Zheng
authors.forename: Atif
authors.initials: A
authors.lastname: Zaheer
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.forename: Nita
authors.initials: N
authors.lastname: Ahuja
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Weiss
authors.forename: Jin
authors.initials: J
authors.lastname: He
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology*; D002291:Carcinoma, Papillary / Q000473:pathology*; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009504:Neutrophils / Q000473:pathology*; D049451:Nomograms; D010190:Pancreatic Neoplasms / Q000473:pathology*; D010976:Platelet Count; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor