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. 2018 Feb;15(1):70-78.
doi: 10.20892/j.issn.2095-3941.2017.0152.

A new combined criterion to better predict malignant lesions in patients with pancreatic cystic neoplasms

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A new combined criterion to better predict malignant lesions in patients with pancreatic cystic neoplasms

Chungen Lan et al. Cancer Biol Med. 2018 Feb.

Abstract

Objective: Cystic lesions of the pancreas have been increasingly recognized. Some lesions exhibit benign behavior, while others have unequivocal malignant potential. Thus, accurate identification of malignancy in patients diagnosed with pancreatic cystic neoplasms (PCNs) remains a major challenge. The aim of this study was to define a combined criterion to better predict malignant lesions in patients with PCNs.

Methods: We retrospectively analyzed 165 patients who underwent resection of PCNs from October 2011 to May 2017. The relationship among malignancy and serum carbohydrate antigen 19-9 (CA19-9), preoperative neutrophil-to-lymphocyte ratio (NLR), and the presence of enhanced solid component on imaging was analyzed.

Results: NLR before surgery in patients with malignant PCNs (2.81±2.14) was significantly higher than that in patients diagnosed with pancreatic neuroendocrine tumor (1.90±0.69, P=0.013) or healthy volunteers (1.40±0.48; P<0.001). Serum CA19-9 ≥39 U/mL, NLR >1.976 and presence of enhanced solid component were independent predictors of PCN malignancy. A combined criterion meeting any two or more of the three elements including CA19-9 ≥39 U/mL, NLR >1.976, and presence of enhanced solid component on computed tomography imaging is an indicator with a high positive predictive value of 80.5% and a high negative predictive value of 87.9%, and thus, represents a highly accurate test (86.1%).

Conclusions: The new combined criterion is an effective predictor of tumor malignancy in patients with PCNs.

Keywords: Malignant pancreatic cystic neoplasm; combined criterion; diagnosis; enhanced solid component; neutrophil-lymphocyte ratio.

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Figures

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(A) A 69-year-old asymptomatic woman with pancreatic body-tail cyst incidentally found by routine examination. (1) Computed tomography (CT) scan shows 8 cm cyst at body-tail of pancreas. (2) Axial contrast-enhanced CT image in portal venous phase demonstrates a large nonenhancing mass in pancreas (arrow). (3) Serous cystic neoplasm (SCN) confirmed by pathology (IHC staining, 20 x). (B) A 48-year-old woman with upper abdominal pain. (1) Computed tomography (CT) scan shows 7 cm cyst at body-tail of pancreas. (2) Axial contrast-enhanced CT image in portal venous phase demonstrates a large enhancing mass in pancreas (arrow). (3) Invasive mucinous cystic neoplasm (MCN) confirmed by pathology (IHC staining, 20 x).
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Distribution of NLR in 603 patients with various types of pancreatic disease is shown. NLR values are compared among these groups. Healthy volunteers (n=330), PDAC: pancreatic ductal adenocarcinoma (n=49), PNET: pancreatic neuroendocrine tumor (n=44), IgG4: IgG4-related sclerosing pancreatitis (n=15), benign PCNs in the study (n=124), malignant PCNs in the study (n=41). *P<0.05, **P<0.01.
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Optimal NLR value for predicting malignant PCNs. Receiver operating characteristic (ROC) curve analysis for determining NLR cut-off value predictive of malignant PCNs is shown. Curved line shows ROC curve. AUC: area under the curve, COV: cut-off value.
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High NLR level is associated with the presence of malignant PCNs. Distributions of NLR level and serum CA19-9 level, presence of enhanced solid component, and presence of malignant lesions in patients with PCNs (n=165) are shown. Each bar chart shows the patient's NLR value, and lower heat map shows if patient meets the criterion. Red arrow shows the high NLR group (>1.976).

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