Dear Editor,
We have read the recent study1 on the interplay between inflammatory biomarkers and nanotechnology in the early detection of pancreatic cancer with great interest. The study offers valuable insights into the potential utilization of nanotechnology to enhance diagnostic capabilities for this devastating disease. The authors adeptly emphasize the significance of inflammatory biomarkers in detecting pancreatic cancer and their association with its development and progression. Through the application of nanotechnology-based approaches, the study1 proposes innovative early detection methods that hold the promise of significantly impacting patient outcomes and survival rates. A notable strength of this study lies in its comprehensive literature review and the integration of knowledge pertaining to inflammatory biomarkers and nanotechnology. The authors effectively present the current state of research in this field, highlighting the need for further investigation and the potential for future advancements. Nevertheless, we believe that additional clarification is necessary regarding the following concerns.
Firstly, we would like to address a concern regarding the age disparity between the healthy control group and the pancreatic ductal adenocarcinoma (PDAC) patients. It is evident that there is a significant age difference between the PDAC patients and the healthy control group [71 (47–83) vs. 58.5 (23–84)], with the PDAC patients appearing to be notably older. In this scenario, a reasonable assumption would be that the observed differences in inflammatory biomarkers between the two groups may not be solely attributable to the presence or absence of PDAC but rather influenced by the age discrepancy between the two cohorts. Therefore, the substantial age difference between the two groups greatly compromises the reliability and accuracy of the conclusions drawn in this study. A previous study2 has indicated that the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) vary across different age groups, with higher NLR and PLR levels observed in older participants. Hence, it is recommended to include healthy control participants of similar age to the PDAC patients, which would mitigate the confounding effect of age disparity. Therefore, addressing this age disparity issue through careful participant selection would enhance the validity of the study’s findings. It would allow for a more accurate evaluation of the specific impact of PDAC on inflammatory biomarkers, independent of the age factor.
Secondly, based on the data presented in Table S1 of the study1, it is evident that the majority of the recruited PDAC patients (75%) are classified as TNM stage III or IV, with only a minority (25%) falling into TNM stage I or II. This distribution raises concerns about the appropriateness of characterizing the study as focusing on ‘pancreatic cancer early detection,’ as the majority of the included PDAC cases belong to advanced stages of the disease. Therefore, by specifically targeting TNM stage I or II PDAC patients, the study can conduct a more precise assessment of the potential effectiveness of inflammatory biomarkers and nanotechnology in the early detection of pancreatic cancer. This approach would yield valuable insights into the diagnostic value of these markers for identifying PDAC at its nascent stages, when treatment options and prognoses tend to be more favorable. Moreover, differentiating between early-stage and advanced-stage PDAC patients would provide a clearer understanding of the practical applicability and limitations of the proposed diagnostic methodologies.
Ethical approval
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Sources of funding
Not applicable.
Author contribution
The design and composition of this letter were undertaken by Yao Wang, Wenming Feng, and Chengwu Tang.
Conflicts of interest disclosure
The authors declare that they have no conflicts of interest.
Research registration unique identifying number (UIN)
Not applicable.
Guarantor
Chengwu Tang.
Data availability statement
This letter does not involve any data.
Provenance and peer review
Commentary, internally reviewed.
Acknowledgements
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Footnotes
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Published online 11 August 2023
Contributor Information
Yao Wang, Email: dr_wangyao@sina.com.
Wenming Feng, Email: dr_fwm@zjhu.edu.cn.
Chengwu Tang, Email: dr_tcw@zjhu.edu.cn.
References
- 1.Caputo D, Quagliarini E, Coppola A, et al. Inflammatory biomarkers and nanotechnology: new insights in pancreatic cancer early detection. Int J Surg 2023. [Epub ahead of print]. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Wu L, Zou S, Wang C, et al. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in Chinese Han population from Chaoshan region in South China. BMC Cardiovasc Disord 2019;19:125. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
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Data Availability Statement
This letter does not involve any data.