• Annals of surgery · Aug 2017

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

    • Georgios Gemenetzis, Fabio Bagante, James F Griffin, Neda Rezaee, Ammar A Javed, Lindsey L Manos, Anne M Lennon, Laura D Wood, Ralph H Hruban, Lei Zheng, Atif Zaheer, Elliot K Fishman, Nita Ahuja, John L Cameron, Matthew J Weiss, Jin He, and Christopher L Wolfgang.
    • *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.
    • Ann. Surg. 2017 Aug 1; 266 (2): 339-345.

    ObjectiveTo 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).BackgroundNLR and (PLR) are inflammatory markers that have been associated with overall survival in patients with invasive malignancies, including pancreatic cancer.MethodsWe 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.ResultsNLR 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.ConclusionsNLR 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.

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