Prognostic Impact of Inflammatory Markers and Triglyceride–Glucose Index in Pancreatic Neuroendocrine Tumors

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-func-tional 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% 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.

Keywords: Neutrophil-to-lymphocyte ratio, pancreatic neuroendocrine tumors, platelet-to-lymphocyte ratio, prognosis, survival, triglyceride–glucose index