{
  "abstract": "Background and Objectives: This study evaluated whether preoperative neutrophil-to-lymphocyte ratio (NLR) improves prediction of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy. Materials and Methods: This single-center retrospective cohort included 120 of 158 patients operated on between January 2019 and March 2026; 38 lacked documented pancreatic duct diameter. CR-POPF followed the 2016 International Study Group on Pancreatic Surgery definition. A random forest incorporating duct diameter, estimated blood loss, and NLR was compared with a model omitting NLR and penalized logistic regression using 10-times-repeated stratified five-fold cross-validation. Post hoc clinicopathological sensitivity analyses added pancreatic texture and tumor origin, then tested inflammatory–nutritional markers individually. Discrimination, average precision, Brier score, calibration, and exploratory decision-curve analysis were assessed. Results: CR-POPF occurred in 16 patients (13.3%). Biochemical leak occurred in 28 (23.3%). The NLR-integrated model achieved an area under the receiver operating characteristic curve (AUC) of 0.721 (95% confidence interval [CI], 0.576–0.850), versus 0.760 for the comparator and 0.736 for penalized logistic regression. Expanded baseline AUC was 0.743; adding NLR yielded 0.715. Monocyte-to-lymphocyte ratio increased AUC numerically to 0.779, but the paired difference remained uncertain (ΔAUC, 0.037; 95% CI, −0.017 to 0.096). Other evaluated markers showed no clear incremental benefit. Postpancreatectomy acute pancreatitis occurred in seven (5.8%). Conclusions: NLR did not demonstrate incremental predictive value. The monocyte-to-lymphocyte ratio finding was hypothesis-generating. Small event numbers and predictor selection outside cross-validation limit interpretation; performance may remain optimistic. These findings do not support clinical implementation without independent external validation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Surgical Oncology, Ankara City Hospital, 06800 Ankara, Türkiye"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Gizem Gunes",
      "orcid": "0000-0001-5761-4052"
    },
    {
      "affs": [
        0
      ],
      "name": "Adem Ozcan",
      "orcid": "0000-0003-2432-7334"
    },
    {
      "affs": [
        0
      ],
      "name": "Abdulkadir Unsal"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1cfs9x5rhdxxs.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15218379",
  "fulltext_url": null,
  "id": "1cfs9x5rhdxxs",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/21/8379",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2730|Pancreatic and Hepatic Oncology Research"
    ]
  ],
  "openalex": "W7224080886",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-28",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/1cfs9x5rhdxxs.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:01Z",
      "native_id": "10.3390/jcm15218379",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/21/8379"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Pancreatic and Hepatic Oncology Research",
      "subfield": "oncology"
    }
  ],
  "title": "Internal Evaluation of a Machine Learning-Based Random Forest Model for Clinically Relevant Postoperative Pancreatic Fistula After Pancreaticoduodenectomy: Limited Incremental Value of Inflammatory–Nutritional Markers",
  "title_text": "Internal Evaluation of a Machine Learning-Based Random Forest Model for Clinically Relevant Postoperative Pancreatic Fistula After Pancreaticoduodenectomy: Limited Incremental Value of Inflammatory–Nutritional Markers",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:01Z",
  "url": "https://research.draconitic.com/paper/1cfs9x5rhdxxs",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}