International Journal of Medicine Research

Authors
Sindhu RS, Ramesh Rajan, Antony Stanley, Fahaduzzaman P, Bonny Natesh P

Abstract
Introduction: Chronic pancreatitis (CP) is a premalignant condition for carcinoma pancreas. Worrisome lesions in CP in pancreatic head warrant pancreatico-duodenectomy because CA19-9/CECT/MRI-MRCP/PET/EUS-FNA often fail to differentiate inflammatory and malignant lesions. Objective of this study was to assess predictive values of NLR, PLR and CA19-9 for malignant CP. Methodology: Single centre retrospective analysis done in Department of Surgical Gastroenterology, Medical College, Trivandrum, Kerala; on CP (Group-1) and carcinoma pancreas (Group-II) from 1/1/2014-31/12/2018. Group-I was stratified as CP-benign (Group-IB) and CP-malignant (Group-IM). From their absolute neutrophil count, lymphocyte count and platelet counts, NLR and PLR values were calculated. ROC analyses done for cut off values with PPV and NPV. Results: 255 patients; enrolled into Group-I (n=113; 75.92% Group-IB and 24.07% Group-IM) and Group-II (n=142). By ROC, sensitivity, specificity, PPV, NPV; and accuracy of Group-I with NLR cut off value of 2.345 were 68.11%/73.72%/59.62/91.80% and with 2.813, were 58.3%/90.2%/72.4%/82.14%. For PLR; with cut off at 138.65 were 63.89%/88.5%/69.7%/83.75%; and with 157.95 were 48.6%/91.8%/70.83%/78.65%. Discussion: By ROC, CA19-9 of 100.21U/ml showed 82.9% sensitivity and 85.2% Specificity for malignant CP. NLR of 2.345 showed 68.11% sensitivity, 73.72% specificity, 59.62 PPV and 91.80% NPV; 2.813 had 58.3% sensitivity, 90.2% specificity, 72.4% PPV and 82.14% NPV. PLR of 138.65 showed 63.89% sensitivity, 88.5% specificity, 69.7% PPV and 83.75% NPV and 157.95 had 48.6% sensitivity, 91.8% specificity, 70.83% PPV and 78.65% NPV. Conclusion: NLR and PLR in CP carcinoma and denovo-DACP were comparable. NLR and PLR have showed significant predictive values, comparing benign and malignant CP.