Mean Platelet Volume-to-Platelet Ratio as a Preoperative Marker for Distinguishing Pancreatic Cancer and Chronic...

Background Differentiating pancreatic cancer from chronic pancreatitis remains clinically challenging due to the overlap of symptoms, biochemical abnormalities and imaging characteristics. Carbohydrate antigen 19-9 (CA 19-9) is a very common marker employed in the assessment of pancreatic cancer but is not sufficiently specific because it has been shown to be elevated in cases of inflammatory and obstructive pancreaticobiliary disease. A new and easy-to-obtain platelet-derived inflammatory marker, mean platelet volume to platelet ratio (MPR), may provide further utility in the differentiation of malignant and benign inflammatory pancreatic disease. Objective We aimed to assess the MPR value in the diagnosis of pancreatic cancer versus chronic pancreatitis in patients undergoing pancreatic surgery. Materials and methods This was a prospective diagnostic accuracy study carried out in the Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery, Bangladesh Medical University, Dhaka, from September 2023 to August 2024. Adult patients who underwent pancreatic surgery for suspected pancreatic cancer or chronic pancreatitis were included. The final histopathological diagnosis of the surgical specimen was used as the reference standard. Patients who had an acute medical condition or psychiatric condition were excluded. A total of 35 patients were included (18 with pancreatic cancer and 17 with chronic pancreatitis). A structured checklist was used to obtain demographic, clinical and laboratory data. Preoperative laboratory parameters within seven days of surgery were used to calculate MPR, which is defined as mean platelet volume (MPV) divided by platelet count. The accuracy of diagnosis was determined by receiver operating characteristic curve analysis. Results There was no significant difference between the two groups in terms of age, sex, or body mass index (BMI). Chronic pancreatitis was significantly more likely to have endocrine and exocrine insufficiency. Significantly elevated concentrations of serum amylase, lipase, MPV, MPR, total bilirubin and CA 19-9, along with decreased platelet counts, were seen in individuals with pancreatic cancer. Chronic pancreatitis was more often associated with diabetes mellitus, whereas an American Society of Anaesthesiologists (ASA) score of 1 was associated with pancreatic cancer. MPR demonstrated high diagnostic performance, with an AUC of 0.908, sensitivity of 83.3%, specificity of 100.0%, a Youden index of 0.833, and a cutoff value of 0.053. MPV showed good discriminatory performance, CA 19-9 showed fair discriminatory performance, platelet count showed strong inverse discriminatory ability, and CEA had little diagnostic utility. Conclusions MPR may serve as a low-cost and easily available adjunctive preoperative marker for differentiating pancreatic cancer from chronic pancreatitis; however, its cutoff value and clinical applicability require validation in larger, multicentre prospective cohorts.