Background: The C-reactive protein (CRP)-toserum albumin ratio is associated with a poor prognosis in patients with several cancers. The purpose of this study was to clarify the relationship between the preoperative CRP/Alb ratio and overall survival of pancreatic ductal adenocarcinoma (PDAC) in patients who received radical surgery and S-1 adjuvant chemotherapy. Patients and Methods: We included 117 patients who underwent radical surgery with S-1 adjuvant chemotherapy. We constructed receiver operating characteristic curve (ROC curve) of the CRP/Alb ratio to determine the cutoff value. We analyzed the relationship among the CRP/Alb ratio, clinicopathological status, and survival. Results: The optimal cutoff value of the CRP/Alb ratio was 0.036. All patients were divided into a high-ratio group (CRP/Alb ratio ≥0.036) and low-ratio group (CRP/Alb ratio <0.036). The 5-year overall survival (OS) rates in the high-and low-ratio groups were 22.5% and 36.4%, respectively (p=0.0089). The 5-year disease-free survival (DFS) rates in the high-and low-ratio groups were 12.5% and 22.1%, respectively (p=0.0097). The univariate and multivariate analyses of the OS showed that the pathological N factor and CRP/Alb ratio were independent factors of the survival. The univariate and multivariate analyses of the RFS showed that the pathological N factor, resection margin, and CRP/Alb ratio were independent factors of the survival. Conclusion: The preoperative CRP/Alb ratio is a strong prognostic factor for PDAC patients with undergo curative resection with S-1 adjuvant chemotherapy. Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer death with a 5-year relative survival of 8% (1, 2). It has been estimated that pancreatic cancer will become the second leading cause of cancer death in the United States by 2030 (3). Complete surgical resection and perioperative adjuvant treatment is the only chance for a cure. In Japan, the Japan Adjuvant Study Group of Pancreatic Cancer (JASPAC) showed that S-1 (oral fluorouracil) adjuvant chemotherapy improved the overall survival (OS) and the disease-free survival (DFS) for completely resected pancreatic cancer patients with a 5-year OS and 3-year DFS of 44.1% and 22.6%, respectively (4). The relationship between systemic inflammation and tumor progression has been reported in several investigations, with the involvement of the neutrophil-tolymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and Glasgow Prognostic Score (GPS) suggested (5-7). Recently, the CRP/Alb ratio has been associated with poor outcomes in patients in renal cell carcinoma, gastric cancer, hepatocellular carcinoma, and systemic inflammation diseases (8-11). The C-reactive protein (CRP)-to-serum albumin ratio was first developed as a predictive system of critically ill patients (12). However, there are few reports that have investigated the prognostic and predictive value of the CRP/Alb ratio in PDAC patients preoperatively.

Background: Neuroendocrine carcinoma (NEC) originating from the extrahepatic bile duct (EHBD) is very rare but is known for its aggressiveness and poor prognosis. We herein report a case of rapidly progressed NEC in the extrahepatic bile duct. Case presentation: An 84-year-old man was referred to our facility with obstructive jaundice and abdominal pain. Imaging studies revealed an irregular filling defect in the middle bile duct by endoscopic retrograde cholangiopancreatography and an enhanced wall thickening from the middle to distal portion by enhanced computed tomography. The patient was initially diagnosed with extrahepatic cholangiocarcinoma by a bile duct biopsy and underwent pancreatoduodenectomy with lymph node dissection. The pathological findings showed an NEC with an adenosquamous carcinoma component in the extrahepatic bile duct with lymph node metastases. The patient experienced multiple liver metastases 1 month after surgery and died 3 months after surgery. Due to the rapid progression of his disease, his general condition deteriorated, and he was unable to receive any additional treatments, such as chemotherapy. Conclusion: As shown in our case, NEC of the EHBD has an extremely poor prognosis and can sometimes progress rapidly. Multimodality treatment should be considered, even in cases of locoregional disease.

<b><i>Objective:</i></b> To investigate the prognostic values of the preoperative modified Glasgow Prognostic Score (mGPS) and carcinoembryonic antigen (CEA) alone and combined in elderly patients with colorectal cancer (CRC) planning to receive curative surgery. <b><i>Methods:</i></b> We retrospectively analyzed 130 elderly patients (aged ≥80 years) with CRC who received curative surgery between 2008 and 2016. The preoperative mGPS and CEA levels were calculated. <b><i>Results:</i></b> Elevated preoperative mGPS or CEA level was significantly associated with shorter relapse-free survival (<i>p</i> = 0.005, both) and cancer-specific survival (<i>p</i> = 0.011 and <i>p</i> &#x3c; 0.001, respectively). Combined use of these two factors improved the predictive accuracy for tumor recurrence relative to that of either factor. <b><i>Conclusion:</i></b> Both mGPS and CEA were independent prognostic factors of CRC in elderly patients receiving curative surgery, but their combination was more accurate.

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