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The diagnostic role of the neutrophil-to-lymphocyte ratio in predicting pancreatic ductal adenocarcinoma in patients with pancreatic diseases

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Abstract

Background

Accurately diagnosing pancreatic ductal adenocarcinomas (PDACs) is challenging because of the loss of vascularity and poor imaging. The neutrophil-to-lymphocyte ratio (NLR) has been reported to predict poor prognosis in several types of malignancy including PDAC; however, the diagnostic role of NLR in PDAC has never been addressed.

Methods

This study retrospectively assessed 297 patients who underwent curative pancreatic resection for pancreatic tumors from 1995−2015, including 140 with PDACs, 58 with pancreatic neuroendocrine tumors (PNETs), 76 with intraductal papillary mucinous neoplasms (IPMNs), 13 with mucinous/serous cyst neoplasms, 7 with solid pseudopapillary neoplasms, and 3 with tumor-forming pancreatitis. The role of preoperative NLR in predicting PDACs was investigated.

Results

Preoperative NLR was significantly higher in patients with PDACs (2.52 ± 1.34) than in patients with PNETs (1.93 ± 0.68, P = 0.0004) and IPMNs (2.17 ± 0.79, P = 0.0253). Only eight patients with PDACs (5.7 %) had NLR >5; of these, three had normal carcinoembyronic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels. Multivariate analysis revealed that abnormal CA19-9 levels, abnormal CEA levels, age >67 years, and NLR >5 were independent predictors of PDACs. Both the specificity and the positive predictive value of NLR >5 for predicting PDACs were 100 %; however, the sensitivity was 4.6 % and the negative predictive value was 43.8 %.

Conclusions

NLR >5 could independently predict the occurrence of PDACs in pancreatic neoplastic disease irrespective of other tumor markers, CEA and CA19-9, in pancreatic disease.

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References

  1. Vincent A, Herman J, Schulick R et al (2011) Pancreatic cancer. Lancet 378(9791):607–620

    Article  PubMed  PubMed Central  Google Scholar 

  2. Li D, Xie K, Wolff R et al (2004) Pancreatic cancer. Lancet 363(9414):1049–1057

    Article  CAS  PubMed  Google Scholar 

  3. Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58(2):71–96

    Article  PubMed  Google Scholar 

  4. Harewood GC, Wiersema MJ (2002) Endosonography-guided fine needle aspiration biopsy in the evaluation of pancreatic masses. Am J Gastroenterol 97(6):1386–1391

    Article  PubMed  Google Scholar 

  5. Balkwill F, Mantovani A (2001) Inflammation and cancer: back to Virchow? Lancet 357(9255):539–545

    Article  CAS  PubMed  Google Scholar 

  6. Coussens LM, Werb Z (2002) Inflammation and cancer. Nature 420(6917):860–867

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Gomez D, Morris-Stiff G, Toogood GJ et al (2008) Impact of systemic inflammation on outcome following resection for intrahepatic cholangiocarcinoma. J Surg Oncol 97(6):513–518

    Article  PubMed  Google Scholar 

  8. Proctor MJ, Talwar D, Balmar SM et al (2010) The relationship between the presence and site of cancer, an inflammation-based prognostic score and biochemical parameters. Initial results of the Glasgow Inflammation Outcome Study. Br J Cancer 103(6):870–876

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Proctor MJ, Morrison DS, Talwar D et al (2011) A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow inflammation outcome study. Eur J Cancer 47(17):2633–2641

    Article  PubMed  Google Scholar 

  10. Zahorec R (2001) Ratio of neutrophil to lymphocyte counts–rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 102(1):5–14

    CAS  PubMed  Google Scholar 

  11. Kishi Y, Kopetz S, Chun YS et al (2009) Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol 16(3):614–622

    Article  PubMed  Google Scholar 

  12. Mano Y, Shirabe K, Yamashita Y et al (2013) Preoperative neutrophil-to-lymphocyte ratio is a predictor of survival after hepatectomy for hepatocellular carcinoma: a retrospective analysis. Ann Surg 258(2):301–305

    Article  PubMed  Google Scholar 

  13. Motomura T, Shirabe K, Mano Y et al (2013) Neutrophil-lymphocyte ratio reflects hepatocellular carcinoma recurrence after liver transplantation via inflammatory microenvironment. J Hepatol 58(1):58–64

    Article  CAS  PubMed  Google Scholar 

  14. Sugiura T, Uesaka K, Kanemoto H et al (2013) Elevated preoperative neutrophil-to-lymphocyte ratio as a predictor of survival after gastroenterostomy in patients with advanced pancreatic adenocarcinoma. Ann Surg Oncol 20(13):4330–4337

    Article  PubMed  Google Scholar 

  15. Paramanathan A, Saxena A, Morris DL (2014) A systematic review and meta-analysis on the impact of pre-operative neutrophil lymphocyte ratio on long term outcomes after curative intent resection of solid tumours. Surg Oncol 23(1):31–39

    Article  PubMed  Google Scholar 

  16. Zhang X, Zhang W, Feng LJ (2014) Prognostic significance of neutrophil lymphocyte ratio in patients with gastric cancer: a meta-analysis. PLoS One 9(11):e111906

    Article  PubMed  PubMed Central  Google Scholar 

  17. Stotz M, Gerger A, Eisner F et al (2013) Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer. Br J Cancer 109(2):416–421

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Luo G, Guo M, Liu Z et al (2015) Blood neutrophil-lymphocyte ratio predicts survival in patients with advanced pancreatic cancer treated with chemotherapy. Ann Surg Oncol 22(2):670–676

    Article  PubMed  Google Scholar 

  19. Stevens L, Pathak S, Nunes QM et al (2015) Prognostic significance of pre-operative C-reactive protein and the neutrophil-lymphocyte ratio in resectable pancreatic cancer: a systematic review. HPB (Oxford) 17(4):285–291

    Article  Google Scholar 

  20. Arima K, Okabe H, Hashimoto D et al (2015) The neutrophil-to-lymphocyte ratio predicts malignant potential in intraductal papillary mucinous neoplasms. J Gastrointest Surg

  21. Halfdanarson TR, Rabe KG, Rubin J et al (2008) Pancreatic neuroendocrine tumors (PNETs): incidence, prognosis and recent trend toward improved survival. Ann Oncol 19(10):1727–1733

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Yao JC, Hassan M, Phan A et al (2008) One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26(18):3063–3072

    Article  PubMed  Google Scholar 

  23. Lee ES, Lee JM (2014) Imaging diagnosis of pancreatic cancer: a state-of-the-art review. World J Gastroenterol 20(24):7864–7877

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wang DS, Luo HY, Qiu MZ et al (2012) Comparison of the prognostic values of various inflammation based factors in patients with pancreatic cancer. Med Oncol 29(5):3092–3100

    Article  CAS  PubMed  Google Scholar 

  25. Hyun S, Kwon S, Cho S et al (2015) Can the neutrophil-to-lymphocyte ratio appropriately predict carotid artery stenosis in patients with ischemic stroke? A retrospective study. J Stroke Cerebrovasc Dis

  26. Bakirci EM, Topcu S, Kalkan K et al (2015) The role of the nonspecific inflammatory markers in determining the anatomic extent of venous thromboembolism. Clin Appl Thromb Hemost 21(2):181–185

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Kota Arima, Hirohisa Okabe, Daisuke Hashimoto, Akira Chikamoto, Akira Tsuji, Kensuke Yamamura, Yuki Kitano, Risa Inoue, Takayoshi Kaida, Takaaki Higashi, Katsunobu Taki, Katsunori Imai, Toru Beppu & Hideo Baba

  2. Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Yoshihiro Komohara & Motohiro Takeya

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  1. Kota Arima
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  2. Hirohisa Okabe
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Correspondence to Hideo Baba.

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Arima, K., Okabe, H., Hashimoto, D. et al. The diagnostic role of the neutrophil-to-lymphocyte ratio in predicting pancreatic ductal adenocarcinoma in patients with pancreatic diseases. Int J Clin Oncol 21, 940–945 (2016). https://doi.org/10.1007/s10147-016-0975-z

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  • DOI: https://doi.org/10.1007/s10147-016-0975-z

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