Preoperative malignancy risk assessment in pancreatic cystic neoplasms using clinical and laboratory parameters

Table 1 Baseline characteristics of patients with pancreatic cystic neoplasms, n (%)/median (minimum-maximum)

Parameters	Overall (n = 70)	Group A (n = 40)	Group B (n = 30)	P value2
Age, years (mean ± SD)	59.59 ± 16.61	52.74 ± 16.85	69.86 ± 9.58	< 0.001
Gender				0.058
Female	42 (60.0)	29 (72.5)	13 (45.4)
Male	28 (40.0)	11 (27.5)	17 (54.6)
Cigarette smoking	7 (10.0)	2 (4.8)	5 (17.9)	0.107
Presence of chronic pancreatitis	18 (25.7)	9 (21.4)	9 (32.1)	0.315
Major comorbidity
Coronary artery disease	11 (15.7)	5 (11.9)	6 (21.4)	0.328
Hypertension	24 (34.3)	14 (33.3)	10 (35.7)	0.837
Diabetes mellitus	25 (35.7)	9 (21.4)	16 (57.1)	0.002
Other	9 (12.9)	3 (7.1)	6 (21.4)	0.142
Localization of tumor
Head	39 (55.7)	17 (42.5)	22 (73.3)	0.031
Body	21 (30.0)	16 (40)	5 (16.6)	0.070
Tail	9 (12.9)	6 (15)	3 (10.1)
Extensive	1 (1.4)	1 (2.5)	0
Length of tumor (long-axis, mm)	35 (25-55)	30 (20-60)	40 (25-50)	0.838
Mural nodule (preoperative screening)	26 (37.1)	2 (5)	24 (80)	0.012
Mural nodule diameter (mm)	7.8 (5-12)	5.5 (5-6)	8.8 (5-12)	0.035
Pancreatic duct diameter (mm)	8.8 (< 5-15)	6.9 (< 5-11)	9.4 (< 5-15)	0.044
Pathological diagnosis
Serous neoplasms	9 (12.9)	9 (22.5)	0
Mucinous cystic neoplasm	11 (15.7)	9 (22.5)	2 (6.7)
IPMN	16 (22.9)	22 (55)	26 (86.6)
Other1	2 (2.8)	0	2 (6.7)
Laboratory findings, median (IQR)
Red cell distribution width (%)	14.2 (13.5-16)	13.7 (13.3-14.6)	16.2 (14.1-17.3)	< 0.001
Neutrophil-lymphocyte ratio	2.47 (1.95-3.78)	2.33 (1.90-3.53)	2.56 (2.14-4.60)	0.096
Lymphocyte-monocyte ratio	4.01 (2.73-6.50)	4.23 (2.81-6.61)	3.46 (2.50-4.55)	0.112
Platelet-lymphocyte ratio	145 (107-194)	126 (106-157)	178 (118-238)	0.008
Mean platelet volume (10-15L)	8.5 (7.8-9.2)	8.3 (7.9-8.9)	8.7 (7.7-9.3)	0.272
Albumin (g/L)	43 (40-46)	45 (41-46)	41 (34-45)	0.008
CA 19-9 (U/mL)	13.6 (5.2-95)	9.3 (3.2-37.5)	21.7 (12-211.7)	0.009

¹Includes solid pseudopapillary neoplasm (1) and neuroendocrine tumor (1).

²P value for age derived from student’s t-test. P value for gender, presence of chronic pancreatitis, major comorbidities (coronary artery disease, hypertension, diabetes mellitus, other), and localization of tumor derived from Pearson χ² test. P values for cigarette smoking and mural nodule presence derived from Fisher’s exact test. P value for length of tumor, mural nodule diameter, pancreatic duct diameter, and laboratory findings derived from Mann-Whitney U test. P value not calculated for pathological diagnosis due to descriptive nature.

IPMN: Intraductal papillary mucinous neoplasm; IQR: Interquartile range; CA 19-9: Carbohydrate antigen 19-9.

Table 2 Univariate and multivariate regression analyses to predict malignancy or high-grade dysplasia

Parameters	Univariate analysis OR (95%CI)	P value	Multivariate analysis OR (95%CI)	P value
Age	1.095 (1.042-1.150)	< 0.001	1.067 (1.014-1.122)	0.012
Male gender	2.574 (0.957-6.925)	0.061
Diabetes mellitus	4.889 (1.710-13.977)	0.003
Red cell distribution width	2.240 (1.485-3.380)	< 0.001	1.784 (1.172-2.715)	0.007
Neutrophil-lymphocyte ratio	1.145 (0.927-1.414)	0.208
Platelet-lymphocyte ratio	1.005 (0.999-1.012)	0.092
Albumin	0.914 (0.844-0.989)	0.026
CA 19-9	1.003 (0.999-1.007)	0.152

Variance inflation factor for all variables < 5, indicating no significant multicollinearity. CA 19-9: Carbohydrate antigen 19-9; OR: Odds ratio; CI: Confidence interval.

Table 3 Predictive values of independent predictors for malignancy or high-grade dysplasia at optimal cut-off values, n (%)/%

Parameters	Cut-off value1	Number2	Sensitivity	Specificity	PPV	NPV	OR (95%CI)
Age (years)	≥ 60	35 (50.0)	83.3	70.0	65.6	85.7	15.3 (3.8-61.9)
Red cell distribution width (%)	≥ 15.5	25 (35.7)	66.7	82.5	73.9	77.4	22.6 (5.2-97.8)

¹Cut-off values selected using Youden’s method to balance sensitivity and specificity.

²Number of patients above the given cut-off values.

PPV: Positive predictive value; NPV: Negative predictive value; OR: Odds ratio; CI: Confidence interval.