Differentiating early-stage pancreatic cancer from benign masses: the diagnostic superiority of immuno-nutritional indices

The accurate preoperative differentiation of early-stage pancreatic ductal adenocarcinoma (PDAC) from benign/premalignant masses remains a clinical challenge. This study aimed to evaluate the diagnostic value of systemic immuno-nutritional indices (CALLY, PNI, NLR, PLR, CAR) in predicting early-stage PDAC by excluding the statistical bias created by advanced-stage tumor burden. A retrospective analysis was conducted on 75 patients who underwent surgical resection for a pancreatic mass between September 2020 and February 2026. Patients were divided into an early-stage (Stage 1 and 2 A) malignant group ( n = 21) and a benign/premalignant group ( n = 54). The diagnostic performance of indices calculated from routine preoperative blood tests was evaluated using ROC curve and multivariate logistic regression analyses. In the malignant group, NLR ( p = 0.010) and PLR ( p = 0.007) were significantly higher, whereas PNI ( p = 0.001) and CALLY ( p = 0.011) indices were significantly lower compared to the benign group. ROC analysis revealed that PNI had the highest diagnostic accuracy for predicting early-stage malignancy (AUC: 0.757), followed by PLR (AUC: 0.700), NLR (AUC: 0.691), and CALLY (AUC: 0.690). In multivariate logistic regression models, PNI (OR: 0.870), CALLY (OR: 0.360), NLR (OR: 2.204), and PLR emerged as independent predictors of malignancy, outperforming the standard tumor marker CA 19 − 9. Cost-effective and non-invasive immuno-nutritional indices, particularly PNI and CALLY, are promising independent predictors with high diagnostic value that may complement traditional clinical evaluation in differentiating early-stage pancreatic masses from benign lesions.