**5. Conclusion**

adjacent tissues, which in turn promotes the formation of metastases [20]. Solid tumors such as renal, gastric, and colon malignancies produce IL-6, which induces the proliferation and differentiation of megakaryocyte progenitors through specific receptors. This process causes platelet activation and aggregation. Platelet size has been shown to reflect changes in the level

According to the literature, lymphocytes play a key role in cytotoxic cell death and the production of cytokines that inhibit proliferation and metastatic spread of tumor cells. In contrast, neutrophils have a protumor effect by being the primary source of circulating angiogenesisregulating chemokines, growth factors, and proteases [4]. Elevated neutrophil levels may result in an increase in angiogenesis, which promotes development and progression of the neoplasm [6]. Therefore, NLR can be considered as the balance between protumor inflammatory status and antitumor immune status. At present, there is little information on the relevance of these prognostic markers to both diagnosis and monitoring of PAC. Similarly as being in our experience, newly diagnosed PAC patients have high NLR and PLR values than healthy human.

Even with decades passed, measurement of this parameter is still not standardized, as it can easily be obtained with electronic meters. This is a major flaw because many pre-analytical and analytical variables can affect platelet size. The pre-analytical variables include vascular occlusion method, the correctness of the filling of the vial and the mixing of the sample, the type of anticoagulant, the storage temperature and the duration of the analysis. Any inflam-

In practice, these markers, if used alone, may have a low positive predictive value in screening an asymptomatic population. Getting in touch with EDTA, *ethylene diamine tetra acetic acid*, the most common anticoagulant used in laboratory practice, effects the platelet morphology and leads to swelling and an increase in volumes. The differences in the methodology of platelet counting with different automated analytics are most like to be major analytical variable for

The poor standardization of the number of physiological variables affecting platelet size and the poor standardization of this parameter makes it very unlikely that small differences in this parameter, defined by clinical trials in various clinical conditions, could be used for clinical purposes. In the future, better methodological standardization and more personalized reference intervals may make them as a reliable parameter for differential diagnosis and prognostic identification in daily clinical practice, but there is a need for well-designed clinical trials to confirm this hypothesis [23].

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

matory or malignant process can lead to an increase in these parameters [21].

of platelet stimulation and the rate of platelet production.

50 Biomarker - Indicator of Abnormal Physiological Process

**3. Diagnostic weakness and missing points**

**4. Diagnostic efficiency and strengths**

the measurement [22].

As in our results and the literature, the patients with PAC have higher levels of these biomarkers than healthy people. Thus, patients with high NLR, PLR, and MPV with suspicious symptoms and/or signs of PAC are candidates for early evaluation, which can prevent delay in the diagnosis of PAC. Therefore, prospective studies with inflammatory marker screening as IL-6, TNF on a larger number of asymptomatic patients are needed to compare the performance of NLR, PLR, and MPV with that of other diagnostic and monitoring tests to confirm their diagnostic utility.
