**4. Diagnostic efficiency and strengths**

Certainly, the most important advantage is their cost-efficiency. In routine analyzes of PAC, several parameters have been being used at high cost. These parameters have so low cost which cannot be easily overlooked. Additionally, we speculate that increased MPV in a patient group newly diagnosed with PAC may be a reflection of ongoing inflammation, and it can be related to increased levels of cytokines, particularly IL-6. Thus, we suggest that MPV could be used for detection of PAC instead of CA19-9. Increased MPV value, an indicator of platelet volume, points the presence of a subpopulation of young, metabolically and enzymatically more active platelets taking part in the process of homeostasis. NLR and PLR are two representative indices of systemic inflammation [24]. It has been shown that a preoperative NLR of greater than 4 or 5 is associated with a poor outcome in gastric cancer, non-small-cell lung cancer, and ovarian cancer. Neutrophils and leukocytes play a crucial role in the host systemic inflammatory response. A nonspecific systemic inflammatory response due to a tumor leads to an increase in the levels of circulating neutrophils and an elevated NLR, all of which are also clearly demonstrated in our study.
