Background: The present study aimed to investigate the prognostic significance of preoperative main pancreatic\nduct dilation and the neutrophil-to-lymphocyte ratio (PD-NLR) in pancreatic neuroendocrine tumors (PNETs) of the\nhead after curative resection.\nMethods: Sixty-four consecutive PNETs of the head that underwent curative resection were included in the study.\nPreoperative main pancreatic duct dilation (PD) was defined as a pancreatic duct dilation greater than 3mm before\nsurgery. Patients with both PD and an elevated NLR (> 3.13), with PD or elevated NLR, or neither of these characteristics\nwere allocated a PD-NLR score of 2, 1, or 0, respectively. Univariate, multivariate and Kaplan-Meier analyses were used\nto calculate overall survival (OS) and disease-free survival (DFS).\nResults: Preoperative PD-NLR score was correlated with tumor size (P = 0.005), T-stage (P = 0.016), lymph node\nmetastasis (P < 0.001), distant metastasis (P = 0.005), type of hormone production (P = 0.006), perineural invasion (P = 0.014),\nand WHO classification (P < 0.001). Patients with a high PD-NLR score had a significantly poor OS and DFS relative to those\nwith a low PD-NLR score (P < 0.001). In the multivariate analysis, PD-NLR score was an independent predictor of OS and\nDFS for PNET of the head (both P < 0.05). In the analyses of the various subgroups, preoperative PD-NLR score was also a\npredictor of OS and DFS. Additionally, the survival predictive capability of PD-NLR score was superior to that of WHO\nclassification.\nConclusions: Despite the retrospective nature and small sample size of the present study, the results suggest that\npreoperative PD-NLR score can serve as an independent prognostic marker of early survival in patients with PNETs of the\nhead undergoing curative resection. Further large prospective studies are necessary to validate our findings.
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