ObjectiveTo explore value of preoperative neutrophil-to-lymphocyte ratio (NLR) combined with carbohydrate antigen 19-9 (CA19-9) in evaluating prognosis for patients with pancreatic head carcinoma.MethodsThe clinical data of patients with pancreatic head carcinoma underwent radical pancreaticoduodenectomy in the Lanzhou University Second Hospital from February 2011 to August 2017 were retrospectively analyzed. The preoperative serum albumin (ALB), CA19-9, NLR, carcino-embryonic antigen (CEA), alpha-fetoprotein (AFP), N stage, tumor differentiated degree, and other indicators were recorded and the patient’s overall survival was recorded. Linear correlation analysis was used to examine the association of NLR with serum CA19-9. The receiver operating characteristic (ROC) curve was used to calculate the cutoff values of NLR and CA19-9 corresponding to the overall survival rate of 2-year. Kaplan-Meier method was used for survival analysis. Cox proportional hazards regression model was used to evaluate the prognostic value of preoperative CA19-9 and NLR.Results① A total of 121 patients were enrolled in this study. There was no significant correlation between the preoperative serum CA19-9 and NLR (r=0.100 05, P=0.272 9). ② Multivariate analysis showed that higher NLR, higher CA19-9 level, higher N stage, and lower tumor differentiation were the risk factors for overall survival of pancreatic head carcinoma (P<0.05). ③ The cutoff values of CA19-9 and NLR in evaluating the 2-year overall survival rate were 123.3 U/mL and 2.34 respectively by the ROC curve analysis, the area under ROC curve of CA19-9, NLR, and CA19-9 combined with NLR were 0.763, 0.686, and 0.823, respectively. ④ The proportions of patients with CEA≥5 μg/L and ≥N1 stage were higher in the patients with CA19-9≥123.3 U/mL as compared with patients with CA19-9<123.3 U/mL (P<0.05); The proportions of patients with preoperative serum ALB level <35 g/L and CEA≥5 μg/L, ≥N1 stage, and poor differentiation were higher in the patients with NLR≥2.34 as compared with the patients with NLR<2.34 (P<0.05). ⑤ Kaplan-Meier survival analysis showed that patients with CA19-9≥123.3 U/mL and NLR≥2.34 had worse overall survival than those patients with CA19-9<123.3 U/mL and NLR<2.34 (HR=3.599, P<0.01; HR=2.506, P<0.01). The patients with CA19-9≥123.3 U/mL and NLR≥2.34 (n=42), CA19-9≥123.3 U/mL or NLR≥2.34 (n=48), CA19-9<123.3 U/mL and NLR<2.34 (n=31) had better overall survival in turn (overall and between groups, all P<0.01).ConclusionPreoperative serum CA19-9 combined with NLR has an important value in evaluating prognosis for patients with pancreatic head carcinoma.
ObjectiveTo investigate the predictive value of preoperative D-dimer, CA19-9, neutrophil-to-lymphocyte ratio (NLR) in the diagnosis of pancreatic cancer. MethodsThe clinicopathologic data of patients who underwent pancreaticoduodenectomy for pancreatic occupying lesions in the First and Fifth Affiliated Hospitals of Xinjiang Medical University from January 2016 to December 2019 were analyzed retrospectively. According to the pathological characteristics, the patients were divided into pancreatic cancer and pancreatic benign tumour. The gender, age, accompanying diseases, preoperative D-dimer, CA19-9, lymphocyte count, neutrophil count, NLR and so on were compared between them. The receiver operating characteristic (ROC) curves of preoperative D-dimer, CA19-9, and NLR for diagnosis of pancreatic cancer were draw. ResultsA total of 142 patients were collected, including 79 patients with pancreatic cancer and 63 patients with pancreatic benign tumour. Compared with the patients with pancreatic benign tumour, the age was older (P<0.05), the number of neutrophils was more (P<0.05), the number of lymphocytes was less (P<0.05), the preoperative levels of CA19-9 and D-dimer, and the preoperative NLR were higher (P<0.05) for the patients with pancreatic cancer. The multivariate analysis of logistic regression revealed that the preoperative higer CA19-9, D-dimer, and NLR increased the incidence of pancreatic cancer (P<0.05), then the optimal cut-off value of preoperative levels of CA19-9 and D-dimer, and preoperative NLR on diagnosis of pancreatic cancer was 108 U/mL, 306 μg/L and 3.2, respectively, the corresponding area under ROC curve was 0.900, 0.891, 0.768, respectively, and which of combination of preoperative CA19-9, D-dimer, and NLR was 0.931. For the pancreatic cancer patients with preoperative NLR, CA19-9, and D-dimer higher than the optimal cut-off value, the proportions of patients with pTNM stage Ⅲ and lymph node metastasis were higher than those for pancreatic cancer patients with below than optimal cut-off value (P<0.05). ConclusionFrom preliminary study results, preoperative CA19-9, D-dimer, and NLR values have certain values in diagnosis of pancreatic cancer, and diagnostic value of combined detection of 3 indexes is higher than single index.