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Increased Circulating/Systemic Neutrophil-Lymphocyte Ratio Predicts Recurrence After Curative Resection in Patients With Well-Differentiated Pancreatic Neuroendocrine Neoplasm Based on the 2017 World Health Organization Classification: A Single-Center Retrospective Study
Hideo Ohtsuka
Department of Surgery, Tohoku University Graduate School of Medicine
Corresponding Author
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Background 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. Therefore, we assessed the recurrence predictive ability of such markers after curative resection in patients with these neoplasms.
Methods Circulating/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.
Results Univariate 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.
Conclusions The 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.
Keywords
Neutrophil-lymphocyte ratio (NLR), Pancreatic neuroendocrine neoplasm (PanNEN), Systemic immune-inflammatory marker
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Additional file 1: Fig. S1. ROC curve for the NLR and tumor size in well-differentiated PanNENs The ROC curve illustrated that NLR has an AUC of 0.664 (95% CI 0.464-0.864) and tumor size has an AUC of 0.801 (95% CI 0.675-0.945). Arrows indicate optimal cutoff values. Additional file 2: Fig. S2. Recurrence-free-survival and overall survival for PanNENs stratified by the 2017 WHO classification Recurrence-free-survival and overall survival of neuroendocrine carcinoma (NEC) were significantly shorter than those of well-differentiated PanNENs (NET G1-3). Additional file 3: Fig. S3. Distribution of NLR in PanNENs stratified by the 2017 WHO classification The value of NLR in patients with NEC was significantly higher than that in patients with well-differentiated PanNEN.
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This preprint is under consideration at BMC Surgery. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Increased Circulating/Systemic Neutrophil-Lymphocyte Ratio Predicts Recurrence After Curative Resection in Patients With Well-Differentiated Pancreatic Neuroendocrine Neoplasm Based on the 2017 World Health Organization Classification: A Single-Center Retrospective Study
Hideo Ohtsuka
Department of Surgery, Tohoku University Graduate School of Medicine
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 30 Dec, 2020
No community comments so far
Review #1 received
Received 08 Jan, 2021
Reviewer #1 agreed
On 30 Dec, 2020
Reviewer #7 agreed
On 30 Dec, 2020
Reviewer #6 agreed
On 30 Dec, 2020
Reviewer #4 agreed
On 30 Dec, 2020
Reviewer #2 agreed
On 30 Dec, 2020
Reviewer #5 agreed
On 30 Dec, 2020
Reviewers invited
Invitations sent on 29 Dec, 2020
Editor assigned
On 29 Dec, 2020
Editor invited
On 28 Dec, 2020
Submission checks complete
On 28 Dec, 2020
First submitted
On 19 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background 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. Therefore, we assessed the recurrence predictive ability of such markers after curative resection in patients with these neoplasms.
Methods Circulating/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.
Results Univariate 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.
Conclusions The 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.
Figure 1
Figure 2
Figure 3