{
  "abstract": "Background: A Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are common pancreatic precursor lesions requiring varying duration of surveillance because of their potential for malignant transformation. Current risk stratification relies predominantly on imaging-based criteria defined by the Kyoto guidelines, while reliable blood-based biomarkers are lacking. The neutrophil-to-lymphocyte ratio (NLR) has been associated with invasive IPMN in surgical resected cases, but its role in routine BD-IPMN surveillance has not been investigated. This study investigated the association between NLR and disease progression in a large surveillance cohort of patients with BD-IPMN. Methods: This retrospective two-center study included patients with image-based diagnosis of BD-IPMN who underwent at least one further follow-up endoscopic ultrasound (EUS) examination between 2006 and 2026 and had an available differential blood count. Disease progression was defined as the development of new worrisome features (WFs), high-risk stigmata (HRS), pancreatic resection for progressive disease, or IPMN-associated carcinoma. Results: A total of 285 patients undergoing 2207 EUS examinations were included, with a mean EUS surveillance duration of 4.8 years. During follow-up, 63 patients (22.1%) developed at least one WF, 4 (1.4%) developed HRS, 11 (3.9%) underwent pancreatic resection, and 2 (0.7%) developed IPMN-associated carcinoma. NLR was significantly elevated in patients who developed WFs (p = 0.0023), HRS (p < 0.0001), underwent pancreatic resection (p = 0.0006), or had high-grade dysplasia (p = 0.0002). Baseline continuous NLR showed no significant discriminatory ability for subsequent disease progression (AUC, 0.563; 95% CI, 0.482–0.635; p = 0.136). Patients with an NLR above the cohort median (>2.36) had approximately twofold higher odds of subsequent disease progression (OR, 2.02; 95% CI, 1.02–3.98). Longitudinal analyses demonstrated significant increases in NLR preceding the development of WFs (p < 0.0001), HRS (p = 0.0265), and pancreatic resection (p = 0.0272). Rising NLR was particularly associated with cyst growth, cyst size ≥30 mm, and main pancreatic duct dilation. Conclusions: Elevated and increasing NLR was associated with BD-IPMN progression and correlated with established markers of higher-risk disease. Longitudinal NLR assessment may represent a simple and widely available complementary biomarker for surveillance; however, its modest discriminatory performance warrants prospective validation before clinical implementation.",
  "abstract_shown": true,
  "affiliations": [
    "Medizinische Klinik I, Gastroenterology, St. Josef–Hospital Bochum, Hospital of the Ruhr-University Bochum, Gudrunstraße 56, 44791 Bochum, Germany"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 15,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Frederik J. Hansen",
      "orcid": "0000-0002-7452-1189"
    },
    {
      "affs": [
        0
      ],
      "name": "Peter Ewald"
    },
    {
      "affs": [
        0
      ],
      "name": "Luis Sorncharoen"
    },
    {
      "affs": [
        0
      ],
      "name": "Daniel R. Quast"
    },
    {
      "affs": [
        0
      ],
      "name": "Maximilian Stögbauer"
    },
    {
      "affs": [
        0
      ],
      "name": "Christian Torres Reyes"
    },
    {
      "affs": [
        0
      ],
      "name": "Renate Schlottmann"
    },
    {
      "affs": [
        0
      ],
      "name": "Christoph Zeidler"
    },
    {
      "affs": [
        0
      ],
      "name": "Mousa Ayoub"
    },
    {
      "affs": [
        0
      ],
      "name": "Bernadette Kaup"
    },
    {
      "affs": [
        0
      ],
      "name": "Anne Koch"
    },
    {
      "affs": [
        0
      ],
      "name": "Sarah Schellen"
    },
    {
      "affs": [
        0
      ],
      "name": "Lisa Weckheuer"
    },
    {
      "affs": [
        0
      ],
      "name": "Oscar Cahyadi"
    },
    {
      "affs": [
        0
      ],
      "name": "Alanna Ebigbo"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bgpp23km9d8n4.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15197758",
  "fulltext_url": null,
  "id": "bgpp23km9d8n4",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/19/7758",
  "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": "W7221122838",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-08",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/bgpp23km9d8n4.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:00Z",
      "native_id": "10.3390/jcm15197758",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/19/7758"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Pancreatic and Hepatic Oncology Research",
      "subfield": "oncology"
    }
  ],
  "title": "Neutrophil-to-Lymphocyte Ratio Is Associated with Disease Progression in a Surveillance Cohort of Patients with Branch-Duct IPMN",
  "title_text": "Neutrophil-to-Lymphocyte Ratio Is Associated with Disease Progression in a Surveillance Cohort of Patients with Branch-Duct IPMN",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:00Z",
  "url": "https://research.draconitic.com/paper/bgpp23km9d8n4",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}