The platelet-lymphocyte ratio improves the predictive value of serum CA19-9 levels in determining patient selection for staging laparoscopy in suspected periampullary cancer

Surgery
Richard A SmithJ P Neoptolemos

Abstract

The objective of this study was to identify whether the preoperative platelet-lymphocyte (P/L) ratio might improve the predictive value of CA19-9 levels in stratifying a patient group with suspected periampullary malignancy who do not require staging laparoscopy. Patients with suspected periampullary cancer were identified from a prospectively maintained 10-year database. Only patients with resectable disease who underwent staging laparoscopy and subsequent laparotomy were included. Low-risk groups were stratified using a CA19-9 cutoff value of < or = 150 kU/l (or < or = 300 kU/l in patients with a concurrent bilirubin concentration > 35 micromol/l) and a P/L ratio value of < or = 150. From 263 patients, preoperative CA19-9 levels and P/L ratios were available in 216 and 225 patients, respectively. The positive and negative predictive values for resectability, sensitivity, and specificity for CA19-9 levels < or = 150 kU/l were 83%, 36%, 51%, and 73%, respectively. For P/L ratios < or = 150, these levels were 81%, 38%, 51%, and 72%, respectively. When combining the requirement for both CA19-9 levels and P/L ratios to be < or = 150 (n = 38 out of 183), both positive predictive value (95%) and specificity (96%) were improved (Fish...Continue Reading

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