Sercan KİREMİTÇİ, Şerife DEĞİRMENCİOĞLU TOSUN, Elmas BİBERCİ KESKİN, Hakan ŞENTÜRK
Haydarpaşa Numune Medical Journal - 2026;66(3):283-291
Introduction: Pancreatic neuroendocrine tumors (pNETs) are rare neoplasms with heterogeneous biological behavior. Identifying simple, accessible prognostic biomarkers could improve risk stratification. We aimed to evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and triglyceride-glucose (TyG) index in pNETs patients. Methods: This retrospective study included 47 patients with pNETs diagnosed through endoscopic ultrasound-guided fine-needle aspiration/biopsy between January 2012 and December 2024. Patients were grouped as insulinoma (n=10) or non-functional pNETs (n=37). Tumor characteristics, laboratory parameters, inflammatory markers, and TyG index were analyzed. Survival analyses were performed using Kaplan-Meier curves, and the prognostic cutoff value of NLR was assessed by receiver operating characteristic (ROC) analysis. Results: The median age was 61 (47-66) years, and insulinoma patients tended to be younger (46 [27-65]) than non-functional pNETs (62 [53-66]; p=0.122). Tumor size was smaller in insulinomas (14 [11.5-20] mm vs. 20 [15.5-37.5] mm; p=0.019). TyG index was significantly lower in insulinoma patients (4.50+/-0.30 vs. 4.80+/-0.36; p=0.018), but no association was observed between TyG and tumor grade, size, metastasis, or survival. Median NLR and PLR were significantly higher in expired patients compared to survivors (NLR: p=0.003; PLR: p=0.006), while LMR was not significant. ROC analysis demonstrated NLR as a strong predictor of mortality, especially in non-functional pNETs (area under the curve = 0.892, p=0.003; cutoff=2.39; sensitivity 100%; specificity 71%). Furthermore, multivariable Cox proportional hazards regression analysis revealed that metastasis (hazard ratio [HR]: 7.636, 95% confidence interval [CI]: 1.313-44.405, p=0.024) and NLR (HR: 2.248, 95% confidence interval [CI]: 0.973-1.294, p=0.048) were independent predictors for overall survival. Discussion and Conclusion: NLR and PLR are potential independent prognostic biomarkers in pNETs, particularly in non-functional tumors. TyG index showed no significant prognostic value in this cohort. Further prospective studies are required to validate these findings.
