Diagnostic accuracy of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in the differential diagnosis of adrenocortical carcinoma: a retrospective study.

Background: Adrenocortical carcinoma (ACC) is an exceptionally rare and aggressive endocrine malignancy with limited treatment options and poor prognosis. Accurate preoperative differentiation from benign adrenal tumors remains a significant clinical challenge. Systemic inflammatory markers, particularly the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), have emerged as potential diagnostic tools across various malignancies. However, their specific utility in distinguishing ACC from other adrenal tumors, especially in the context of hypercortisolemia, requires further investigation. This study aimed to evaluate the diagnostic accuracy of NLR and PLR for differentiating ACC from non-ACC adrenal tumors in a Chinese cohort. Methods: A retrospective analysis was conducted on patients diagnosed with ACC at The First Affiliated Hospital of Xi'an Jiaotong University from 1985 to 2020. The non-ACC adrenal tumors group included patients with pheochromocytoma, aldosteronoma, Cushing's syndrome (CS) due to adrenocortical adenoma (ACA), and nonfunctioning ACA diagnosed from 2018 to 2020. Demographic, clinical, laboratory, and pathological data were collected. NLR and PLR were calculated from preoperative routine blood tests. Results: This study retrospectively analyzed 45 patients (mean age, 49.33±11.30 years) with ACC, and 533 with non-ACC (mean age, 47.99±12.83 years). The NLR [4.28 (2.58-5.71) Conclusions: For patients without hypercortisolemia, NLR >3 and PLR >140 can be used to differentiate ACC from non-ACC adrenal tumors. For patients with CS, NLR and PLR cannot differentiate ACC from ACA.