The Ratio of C-Reactive Protein to Albumin Is an Independent Predictor of Malignant Intraductal Papillary Mucinous Neoplasms of the Pancreas.

Simone Serafini,Cosimo Sperti,Alberto Friziero,Andrea Grego,Alfredo Piangerelli,Amanda Belluzzi,Lucia Moletta,Lorenzo Vallese

doi:10.3390/jcm10102058

Abstract

There is growing evidence to indicate that inflammatory reactions are involved in cancer progression. The aim of this study is to assess the significance of systemic inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the ratio of C-reactive protein to albumin ratio (CAR), the prognostic nutritional index (PNI) and the modified Glasgow prognostic score (mGps) in the diagnosis and prognosis of malignant intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Data were obtained from a retrospective analysis of patients who underwent pancreatic resection for IPMNs from January 2005 to December 2015. Univariate and multivariate analyses were performed, considering preoperative inflammatory biomarkers, clinicopathological variables, and imaging features. Eighty-three patients with histologically proven IPMNs of the pancreas were included in the study, 37 cases of low-grade or intermediate dysplasia and 46 cases of high-grade dysplasia (HGD) or invasive carcinoma. Univariate analysis showed that obstructive jaundice (p = 0.02) and a CAR of >0.083 (p = 0.001) were predictors of malignancy. On multivariate analysis, only the CAR was a statistically significant independent predictor of HGD or invasive carcinoma in pancreatic IPMNs, identifying a subgroup of patients with a poor prognosis. Combining the CAR with patients’ imaging findings, clinical features and tumor markers can be useful in the clinical management of IPMNs. Their value should be tested in prospective studies.

Highlights

In the pancreas, intraductal papillary mucinous neoplasms (IPMNs) originate from the mucinous epithelium of the pancreatic ductal system
The aim of this study is to assess the significance of systemic inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the ratio of C-reactive protein to albumin ratio (CAR), the prognostic nutritional index (PNI) and the modified Glasgow prognostic score in the diagnosis and prognosis of malignant intraductal papillary mucinous neoplasms (IPMNs) of the pancreas
The present study suggests that the CAR is useful for predicting high-grade dysplasia (HGD) and invasive carcinoma in patients with IPMNs, and that the value of the CAR in detecting malignancies is independent of the well-established parameters indicated in the international guidelines

Summary

Introduction

Intraductal papillary mucinous neoplasms (IPMNs) originate from the mucinous epithelium of the pancreatic ductal system Their incidence is rising, probably due to an increasingly extensive use of cross-sectional imaging, but their management remains controversial. Benign IPMNs can potentially be managed conservatively, whereas malignant IPMNs require surgical resection in accordance with international guidelines. International consensus guidelines (ICG) recommend surgery for cases with one or more “high-risk stigmata” (HRS), while further assessment with endoscopic ultrasonography is suggested for cases with “worrisome features” (WF) [2]. The accuracy of these guidelines in detecting early invasive carcinoma in IPMNs is limited, [3]. There is still a crucial need for markers capable of identifying which IPMNs warrant surgical treatment

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