Preoperative C‐reactive protein to albumin ratio is a predictor of survival after pancreatic resection for pancreatic ductal adenocarcinoma

Abstract

AimSystemic inflammation and nutritional status are associated with clinical outcomes of cancer patients. We investigated the prognostic value of preoperative C‐reactive protein to albumin ratio (CAR) in patients with pancreatic ductal adenocarcinoma (PDA) after pancreatic resection.MethodsOne‐hundred and thirty‐six PDA patients who underwent pancreatic resection between January 2005 and June 2017 were retrospectively enrolled. Preoperative inflammation‐based scores including CAR, modified Glasgow prognostic score (mGPS), neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, lymphocyte to monocyte ratio (LMR) and prognostic nutritional index (PNI) were evaluated as potential predictor of overall survival (OS) using Cox regression models. An optimal cutoff value for the continuous variable was estimated by receiver‐operating characteristic (ROC) analysis.ResultsPatients were categorized by CAR using a cutoff value of 0.09. High CAR was associated with advanced stage, increased mGPS and decreased LMR and PNI, but not with other factors such as tumor location, preoperative biliary drainage or preoperative chemotherapy. In univariate analysis, patients with high CAR had poor OS compared with those with low CAR (P = 0.01). Multivariate analysis indicated that high CAR was an independent predictor of poor OS (P = 0.03) in addition to advanced stage and residual tumors. The predictive ability of CAR evaluated by area under the ROC curve was consistently higher than that of other inflammation‐based factors.ConclusionPreoperative CAR was an independent and superior predictor of survival after pancreatic resection in patients with PDA.[Correction added on 17 January 2019, after first online publication: In Conclusion, “in” has been corrected to “independent” for clarity.]

The Predictive Value of the CRP–to–Albumin Ratio for Patients With Pancreatic Cancer After Curative Resection: A Retrospective Single Center Study

“…Patients with a CAR >0.03 showed a shorter disease-free survival and a decreased survival time in our study population. Compared to Wu et al (19) and Haruki et al (12) this cut-off value seems small, but with the correct conversion factor from mg/l (CRP) to g/dl (albumin) and an average CRP of 15 Ikuta et al (13) have reported greater difference in median overall survival time in patients with higher and lower CAR Kaplan-Meier analysis of our cohort, indicated that CRP and albumin alone were not associated with worse outcome (a: p=0.091, b: p=0.103). According to this, serum levels of CRP alone did not correlate with overall survival in univariate Cox regression analysis.…”

“…CRP is synthesized by hepatocytes and its production is stimulated by proinflammatory cytokines, especially interleukin 6. Research states that inflammatory processes within the tumor activate systematic inflammatory pathways which are detectable and could be related to tumor prognosis and outcome (13,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). The CAR has been described as a strong predictive factor for overall survival of other tumor types, such as intrahepatic cholangiocarcinoma, liver, lung and gastric cancer (10,18,22,23).…”

Prognostic Biomarkers for Pancreatic Ductal Adenocarcinoma: An Umbrella Review

“…A study by Ikuta et al indicated that in 136 PDAC patients, preoperative CAR was an independent poor OS predictor using multivariate analysis. Moreover, the prognostic evaluation power of CAR was significantly higher than other inflammation-based factors such as NLR, platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) (77). Besides, the study by Arima et al also confirmed this result through using CAR at day 14 after an operation (78).…”

The Prognostic Value of Modified Glasgow Prognostic Score in Pancreatic Cancer: A Meta-analysis

“…Ultimately, 20 studies [8,[15][16][17][18][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] including 6512 patients were enrolled in this meta-analysis after excluding ineligible studies.…”