Age and red cell distribution width in pancreatic cystic neoplasms: A simple tool for preoperative malignancy risk stratification

Abstract

The study conducted by Martli et al, on the preoperative risk stratification of malignant potential in pancreatic cystic neoplasms (PCNs), identifies age and red cell distribution width (RDW) as independent predictors. This study offers a simple and cost-effective clinical tool for preoperative assessments. The significance lies in its integration of routine laboratory parameters with clinical features, effectively addressing the limitations associated with the accessibility and operator dependency of imaging and invasive diagnostic methods. However, factors such as the retrospective design, single-center setting, small sample size, and selection bias because of the inclusion of only surgical cases limit the generalizability of the findings. Future studies should emphasize multi-center prospective validation to further clarify the biological role of RDW in the malignant transformation of PCNs and to explore integrated models that combine RDW with imaging characteristics and molecular biomarkers, ultimately enhancing precision in individualized clinical decision-making.

Keywords: Pncreatic cystic neoplasms; Red cell distribution width; Age; Preoperative assessment; Malignancy risk stratification

Core Tip: This article underscores the significance of age and red cell distribution width (RDW) as independent predictors for preoperative malignant risk stratification in pancreatic cystic neoplasms (PCNs). A model that integrates these factors demonstrated high accuracy (area under the curve = 0.858), with age ≥ 60 years and RDW ≥ 15.5% indicating increased risk. This accessible, non-invasive tool may help to identify high-risk patients for intervention, though future multicenter validation is required. The biological role of RDW in the progression of PCN also warrants further study.