The Neutrophil-to-Lymphocyte Ratio Predicts Malignant Potential in Intraductal Papillary Mucinous Neoplasms

Accurately identifying malignant components in patients with pancreatic intraductal papillary mucinous neoplasms (IPMN) remains challenging. Preoperative neutrophil-to-lymphocyte ratio (NLR) is a marker of poor prognosis in patients with several types of malignancy. This study assessed whether NLR was predictive of intraductal papillary mucinous carcinoma (IPMC) in patients with IPMN. This study retrospectively assessed 76 patients who underwent curative resection for IPMN from 1995 to 2015. The correlation between the presence of malignant components and preoperative NLR was analyzed. Preoperative NLR in IPMC was significantly higher in patients with in IPMC (2.51 +/- 0.84) than in patients with intraductal papillary mucinous adenoma (2.01 +/- 0.71, P = 0.0079) and healthy volunteers (1.37 +/- 0.33, P < 0.0001). NLR was significantly reduced after curative tumor resection. The main duct type (P = 0.0231) and NLR > 2.074 (P = 0.0329) were independent predictors of IPMC in all patients. Combined criteria including international consensus guidelines, CA19-9 > 37 IU/ml, and NLR > 2.074 shows a high positive predictive value of 78 % and high specificity of 96 %. Preoperative NLR is a useful supportive marker to predict IPMC in patients with IPMN.