Abstract
BackgroundThe prognostic values of inflammation-based markers in well-differentiated pancreatic neuroendocrine neoplasms, diagnosed according to the new 2017 World Health Organization classification, have remained unclear. Therefore, we assessed the ability to predict the recurrence of such markers after curative resection in patients with these neoplasms.MethodsCirculating/systemic neutrophil–lymphocyte, monocyte–lymphocyte, platelet–lymphocyte, and platelet–white cell ratios were evaluated in 120 patients who underwent curative resection for well-differentiated pancreatic neuroendocrine neoplasms without synchronous distant metastasis between 2001 and 2018. Recurrence-free-survival and overall survival were compared using Kaplan–Meier analysis and log-rank tests. Univariate or multivariate analyses, using a Cox proportional hazards model, were used to calculate hazard ratios with 95% confidence intervals.ResultsUnivariate analysis demonstrated that preoperative neutrophil–lymphocyte ratio, tumor size, European Neuroendocrine Tumor Society TMN classification, 2017 World Health Organization classification, and venous invasion were associated with recurrence. The optimal preoperative neutrophil–lymphocyte ratio cut-off value was 2.62, based on receiver operating characteristic curve analysis. In multivariate analysis, a higher preoperative neutrophil–lymphocyte ratio (HR = 3.49 95% CI 1.05–11.7; P = 0.042) and 2017 World Health Organization classification (HR = 8.81, 95% CI 1.46–168.2; P = 0.015) were independent recurrence predictors.ConclusionsThe circulating/systemic neutrophil–lymphocyte ratio is a useful and convenient preoperative prognostic marker of recurrence in patients with well-differentiated pancreatic neuroendocrine neoplasm based on the 2017 World Health Organization classification.
Highlights
The prognostic values of inflammation-based markers in well-differentiated pancreatic neuroendocrine neoplasms, diagnosed according to the new 2017 World Health Organization classification, have remained unclear
Pancreatic neuroendocrine neoplasm (PanNEN) is a biologically heterogeneous and relatively rare malignancy, with an incidence rate of approximately 5 cases per 1 million person-years, which accounts for 1–2% of primary pancreatic neoplasms [1]
TNM staging was adopted according to the European Neuroendocrine Tumor Society (ENETS) classification [19], and the new 2017 World Health Organization (WHO) classification of NET by the gastro-enteropancreatic (GEP) system was used for histopathological classification [11]
Summary
The prognostic values of inflammation-based markers in well-differentiated pancreatic neuroendocrine neoplasms, diagnosed according to the new 2017 World Health Organization classification, have remained unclear. We assessed the ability to predict the recurrence of such markers after curative resection in patients with these neoplasms. The incidence of PanNEN detected clinically has significantly increased because of the advances in imaging modalities during the past few decades [2]. When the disease is clinically detected before it becomes symptomatic, the lesions are typically localized, increasing the possibility of curative resection and improving prognosis [3]. Surgical resection is currently the only curative treatment for PanNEN [4], recurrence could occur at intervals, and reoperation for recurrent lesions may occasionally be required. It is essential to identify recurrence earlier. For this reason, indicators that could predict recurrence after surgery are required for the optimal management of PanNEN
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