Murshidul Arefin • Md. Kawsar Bhuiyan • Anupam Debnath • Golam Mahmud Rayhan • Sabuj Kumar Patra • Nur Alam Mohim • Mohammad Saief Uddin • Salma A. Tohfa • Amit Chowdhury • Shah Md. Ezaz-ul Haque

The mean platelet volume-to-platelet ratio is a cheap, routinely available blood marker
that may help surgeons separate pancreatic cancer from chronic pancreatitis before
operating. This prospective diagnostic accuracy study, published in Cureus in June 2026,
was led by Dr. Murshidul Arefin at the Department of Hepatobiliary, Pancreatic and Liver
Transplant Surgery, Bangladesh Medical University, Dhaka.

Pancreatic cancer versus chronic pancreatitis: why the distinction is hard

The two conditions overlap heavily in symptoms, biochemical abnormalities and imaging
appearance. Carbohydrate antigen 19-9 (CA 19-9) is the marker used most often to assess
suspected pancreatic cancer, but it is not specific enough — it also rises in
inflammatory and obstructive pancreaticobiliary disease. That leaves a real diagnostic
gap before surgery.

What the mean platelet volume-to-platelet ratio is

The mean platelet volume-to-platelet ratio (MPR) is simply the mean platelet volume
divided by the platelet count, both taken from a standard complete blood count. As a
platelet-derived inflammatory marker it costs almost nothing extra and needs no special
equipment, which matters in resource-limited settings.

Study design

This prospective diagnostic accuracy study ran from September 2023 to August 2024. Adult
patients undergoing pancreatic surgery for suspected pancreatic cancer or chronic
pancreatitis were included; patients with acute medical or psychiatric conditions were
excluded. Thirty-five patients were enrolled — 18 with pancreatic cancer and 17 with
chronic pancreatitis. Final histopathology of the surgical specimen was the reference
standard. Preoperative laboratory values from within seven days of surgery were used to
calculate MPR, and diagnostic accuracy was assessed by ROC curve analysis.

Results

Age, sex and body mass index did not differ significantly between the groups. Chronic
pancreatitis patients were significantly more likely to have endocrine and exocrine
insufficiency and diabetes mellitus. Patients with pancreatic cancer had significantly
higher serum amylase, lipase, mean platelet volume, MPR, total bilirubin and CA 19-9,
with lower platelet counts. MPR performed strongly: AUC 0.908, sensitivity 83.3%,
specificity 100.0%, Youden index 0.833, at a cut-off of 0.053. Mean platelet volume alone
showed good discrimination, CA 19-9 only fair discrimination, platelet count a strong
inverse relationship, and CEA had little diagnostic utility.

Conclusion

The mean platelet volume-to-platelet ratio may serve as a low-cost, widely available
adjunctive preoperative marker for distinguishing pancreatic cancer from chronic
pancreatitis. The cut-off value still needs validation in larger multicentre prospective
cohorts. Read the full study in the PDF below or on Cureus (DOI: 10.7759/cureus.111354).