Neutrophil-to-Lymphocyte Ratio Is Associated with Disease Progression in a Surveillance Cohort of Patients with Branch-Duct IPMN

@article{hansen2026neutrophiltolymphocyte,
  title = {{Neutrophil-to-Lymphocyte Ratio Is Associated with Disease Progression in a Surveillance Cohort of Patients with Branch-Duct IPMN}},
  author = {Frederik J. Hansen and Peter Ewald and Luis Sorncharoen and Daniel R. Quast and Maximilian Stögbauer and Christian Torres Reyes and Renate Schlottmann and Christoph Zeidler and Mousa Ayoub and Bernadette Kaup and Anne Koch and Sarah Schellen and Lisa Weckheuer and Oscar Cahyadi and Alanna Ebigbo},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15197758},
  url = {https://www.mdpi.com/2077-0383/15/19/7758},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Neutrophil-to-Lymphocyte Ratio Is Associated with Disease Progression in a Surveillance Cohort of Patients with Branch-Duct IPMN
AU  - Frederik J. Hansen
AU  - Peter Ewald
AU  - Luis Sorncharoen
AU  - Daniel R. Quast
AU  - Maximilian Stögbauer
AU  - Christian Torres Reyes
AU  - Renate Schlottmann
AU  - Christoph Zeidler
AU  - Mousa Ayoub
AU  - Bernadette Kaup
AU  - Anne Koch
AU  - Sarah Schellen
AU  - Lisa Weckheuer
AU  - Oscar Cahyadi
AU  - Alanna Ebigbo
PY  - 2026
DA  - 2026/10/08
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15197758
UR  - https://www.mdpi.com/2077-0383/15/19/7758
AB  - 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.
SN  - 2077-0383
ER  -