Diagnostic Role of Platelet Lymphocyte Ratio(PLR) in Pancreatic Head Masses

Abstract

Masses in and around pancreas constitute an important clinical entity in gastrointestinal surgical practice. Most common being adenocarcinoma of head of pancreas followed by inflammatory masses due to chronic pancreatitis. Accurate diagnosis is of central importance as therapeutic strategies range from observation to complete surgical removal including total pancreatectomy.Several tumor markers are available which could help in prognostication and diagnosis of carcinoma pancreas. Carbohydrate antigen 19-9(CA 19-9) is traditionally accepted best marker available. The role of new tumor marker platelet lymphocyte ratio (PLR) has been defined recently in prognostication of carcinoma pancreas. Role of PLR in diagnosing and its efficacy after combining it with CA 19-9 is not known. The aim of study was to assess the demographics of histologically proven neoplastic and inflammatory pancreatic head masses in our department. To assess the role of CA19-9 and platelet lymphocyte ratio(PLR) in determining nature of pancreatic head mass. Data consisted of histologically proven 45 patients .23 having head mass due to chronic pancreatitis and 22 because of neoplastic lesions. Demographics in terms of age, sex, previous pain episodes, presence of jaundice, history of alcohol intake were compared in both groups. Also tumor markers CA 19-9 and PLR individually and in combination were compared in both groups. Cancer pancreas significantly (p < 0.001) occurred in older age group, was significantly associated with jaundice (p = 0.005) and weight loss (p < 0.001). Accuracy in diagnosis of cancer pancreas was similar with CA 19-9 and PLR (68.89 %), where as combining CA 19-9 with PLR showed increased sensitivity(81.82 %) and accuracy(71.11 %) in diagnosing cancer pancreas. Other combinations showed no advantage. PLR is at least as good as CA 19-9 as diagnostic marker to differentiate between malignant and inflammatory head mass of pancreas.