Validation of C-reactive protein levels as a prognostic indicator for survival in a large cohort of pancreatic cancer patients

Abstract

Background:Recent evidence indicates that the host inflammatory response has an important role in the tumour progression. Elevated C-reactive protein (CRP) levels have been previously associated with poor prognosis in several cancer types including small-scale studies in pancreatic cancer (PC) patients. The purpose of the present study was to validate the prognostic impact of plasma CRP levels at date of diagnosis on cancer-specific survival (CSS) in a large cohort of PC patients.Methods:Data from 474 consecutive patients with adenocarcinoma of the pancreas, treated between 2004 and 2012 at a single centre, were evaluated retrospectively. CSS was analysed using the Kaplan–Meier method. To evaluate the prognostic significance of plasma CRP levels, univariate and multivariate Cox analyses were applied.Results:High plasma CRP levels at diagnosis were significantly associated with well-established prognostic factors, including high tumour stage and tumour grade and the administration of chemotherapy (P<0.05). In univariate analysis, we observed that a high plasma CRP level was a consistent factor for poor CSS in PC patients (hazard ratio (HR)=2.21; 95% confidence interval (CI)=1.68–2.92, P<0.001). In multivariate analysis, tumour stage, grade, administration of chemotherapy, a high neutrophil–lymphocyte ratio and the highest quartile of CRP levels (HR=1.60, 95% CI=1.16–2.21; P=0.005) were identified as independent prognostic factors in PC patients.Conclusion:In conclusion, we confirmed a significant association of elevated CRP levels with poor clinical outcome in PC patients. Our results indicate that the plasma CRP level might represent a useful marker for patient stratification in PC management.

Neutrophil/lymphocyte ratio helps select metastatic pancreatic cancer patients benefitting from oxaliplatin

“…Later, a ROC analysis was performed and a cut-off value similar to that obtained in our analysis was identified (i.e. NLR 2.3) [32].…”

“…There was no imbalance in KPS between GEM and GEMOXA group (KPS 80 or 90 in 53% and 42% of patients, respectively, chi-square p value = 0.209). Median BMI at treatment start was 23 (range [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34].…”

Reliability of nutritional assessment in patients with gastrointestinal tumors

“…Decreased serum albumin also proved to be an independent prognostic factor for cancer patients with unknown primary site 26 , but further clinical trials are needed to better define the baseline risks in patients with cancer 26-29. Recently, a significant association between increased C-reactive protein (CRP) and poor clinical outcome has been demonstrated in patients with pancreatic cancer 30 . CRP has also been shown to be an independent prognostic indicator in colorectal carcinoma 31 .…”

Prognostic model for survival based on readily available pretreatment factors in patients with advanced pancreatic cancer receiving palliative chemotherapy

“…Several clinical and laboratory factors have been identified as independent prognostic factors in patients with APC [2][3][4][5][6][7][8]. Recently, we reported that an increased neutrophil-lymphocyte ratio (NLR) and the status of initially unresectable disease are associated with a poor prognosis in patients with APC [9,10].…”