Clinical significance of C-reactive protein-to-prealbumin ratio in predicting early recurrence in resectable pancreatic cancer

Abstract

Purpose: Resectable pancreatic ductal adenocarcinoma (PDAC) has a high risk of recurrence after curative resection; despite this, the preoperative risk factors for predicting early recurrence remain unclear. This study therefore aimed to identify preoperative inflammation and nutrition factors associated with early recurrence of resectable PDAC.Methods: From March 2021 to November 2021, a total of 20 patients who underwent curative resection for PDAC were enrolled in this study. We evaluated the risk factors for early recurrence within 1 year by univariate and multivariate analyses using Cox hazard proportional regression. The cutoff values for predicting recurrence were examined using receiver operating characteristic (ROC) curves.Results: In our univariate and multivariate analyses, C-reactive protein (CRP), CRP-albumin ratio, and CRP-prealbumin ratio, as well as sex and age, were significant independent prognostic factors for early recurrence in PDAC. However, known inflammatory factors (neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios), nutritional factors (albumin, prealbumin, ferritin, vitamin D), and inflammatory-nutritional factors (Glasgow Prognostic Score, modified Glasgow Prognostic Score, albumin-bilirubin) showed no association with early recurrence. In addition, using cutoff values by ROC curve analysis, a high preoperative CRP level of >5 mg/L, as well as high CRP-to-albumin (>5.3) and CRP-to-prealbumin (>1.3) ratios showed no prognostic value.Conclusion: Our results showed that inflammatory and perioperative nutritional factors, especially CRP-to-prealbumin ratio, have significant associations with early recurrence after curative resection in resectable PDAC. Therefore, for such patients, a cautious approach is needed when inflammation and poor nutritional status are present.

Fibrinogen-to-prealbumin and C-reactive protein-to-prealbumin ratios as prognostic indicators in severe fever with thrombocytopenia syndrome

“…In recent years, FPR and CPR have emerged as promising indicators capable of capturing both systemic inflammation and nutritional status in various diseases. This combined index of the FPR and CPR holds potential as a prognostic biomarker in patients with conditions such as tumors ( Matsunaga et al., 2020 ; Sun et al., 2020 ; Maruyama et al., 2022 ; Kwon et al., 2023 ), infectious diseases ( Yue et al., 2015 ; Bi et al., 2022 ), autoimmune diseases ( Cheng et al., 2021 ), and other ailments ( Zang et al., 2020 ; Yamada et al., 2021 ; Huang et al., 2022 ). To date, no studies have examined whether FPR and CPR can assess the prognosis of patients with SFTS.…”

“…Additionally, during inflammatory processes, cytokines such as IL-6, IL-1, and TNF-α also contribute to the decrease of PA levels ( Yue et al., 2015 ). The prognostic potential of PA has been demonstrated in various conditions including acute kidney injury ( Xie et al., 2011 ), tumors ( Kwon et al., 2023 ), infectious diseases ( Bi et al., 2022 ), and heart failure ( Lourenço et al., 2014 ). Although PA demonstrated a good predictive ability for mortality among patients with SFTS (AUC = 0.791), statistical significance was not achieved in the univariate analysis ( P = 0.098), likely due to the limited sample size.…”

Inflammatory and nutritional markers in patients with resectable pancreatic cancer

“…Recently, the CRP to prealbumin ratio (CPAR), which is an inflammatory and nutritional marker, has been investigated as a potential prognostic indicator in various cancers [ 6 , 8 ]. In this issue of the Korean Journal of Clinical Oncology , Kwon et al [ 9 ] demonstrated the utility of CPAR in predicting the prognosis of PDAC. The authors aimed to identify patients who were at high risk of early recurrence in cases of resectable PDAC.…”