Association between preoperative neutrophil-to-lymphocyte ratio and malignant intraductal papillary mucinous neoplasms: A systematic review and meta-analysis

doi:10.4251/wjgo.119432

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Aug 15, 2026; 18(8): 119432
Published online Aug 15, 2026. doi: 10.4251/wjgo.119432

Association between preoperative neutrophil-to-lymphocyte ratio and malignant intraductal papillary mucinous neoplasms: A systematic review and meta-analysis

Wen-Wen Dong, Li-Li Zhou, Du-Jiang Yang, Hui-Min Lu

Wen-Wen Dong, Li-Li Zhou, Du-Jiang Yang, Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China

Wen-Wen Dong, Li-Li Zhou, West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China

Hui-Min Lu, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China

Hui-Min Lu, West China Center of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China

Author contributions: Dong WW and Zhou LL performed the literature search and data extraction; Dong WW, Zhou LL, and Yang DJ analyzed the data and drafted the manuscript; Lu HM conceived and designed the study and critically revised the manuscript; and all authors approved the final version of the manuscript.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Hui-Min Lu, MD, PhD, Associate Professor, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, Sichuan Province, China. hm.lu@scu.edu.cn

Received: January 28, 2026
Revised: April 1, 2026
Accepted: May 7, 2026
Published online: August 15, 2026
Processing time: 187 Days and 11.5 Hours

Abstract

BACKGROUND

Intraductal papillary mucinous neoplasms (IPMN) are pancreatic cystic neoplasms with heterogeneous malignant potential. Accurate preoperative identification of malignant IPMN remains clinically challenging. The neutrophil-to-lymphocyte ratio (NLR) has been reported as a simple systemic inflammatory marker associated with tumor progression, but its value in malignant IPMN remains uncertain.

AIM

To determine the association between the preoperative NLR and malignant IPMN.

METHODS

A systematic literature search of Ovid MEDLINE, Web of Science, EMBASE, and the Cochrane Library was performed for studies published before August 30, 2024. Studies evaluating the association between the NLR and malignant IPMN were included. Two reviewers independently conducted study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed. Subgroup and leave-one-out sensitivity analyses were also conducted.

RESULTS

Ten retrospective studies involving 1355 patients were included. An elevated preoperative NLR was significantly associated with malignant IPMN (odds ratio = 2.56, 95% confidence interval: 1.24-5.27; I² = 66%). Subgroup analyses revealed variation across study characteristics, and several subgroups had wide confidence intervals. Leave-one-out sensitivity analysis revealed that the pooled result remained statistically significant after the sequential exclusion of each study. Funnel plot inspection did not show obvious asymmetry, although the small number of studies limited the assessment of publication bias.

CONCLUSION

An elevated preoperative NLR is associated with malignant IPMN and may serve as an adjunctive marker.

Keywords: Neutrophil-to-lymphocyte ratio; Intraductal papillary mucinous neoplasms; Malignancy; Meta-analysis; Pancreatic cystic neoplasms

Core Tip: This meta-analysis suggests that an elevated preoperative neutrophil-to-lymphocyte ratio (NLR) is associated with malignant intraductal papillary mucinous neoplasm. As an inexpensive and readily available inflammatory marker, the NLR may assist in preoperative risk stratification. However, because of study heterogeneity and the nonspecific nature of the NLR, it should be considered an adjunctive marker rather than a standalone predictor.