C-Reactive Protein/Albumin Ratio and Prognostic Nutritional Index Are Strong Prognostic Indicators of Survival in Resected Pancreatic Ductal Adenocarcinoma

Abstract

Purpose: We evaluated the clinical importance, such as the occurrence of postoperative pancreatic fistula (POPF) or prognosis, of preoperative serum markers of chronic inflammation, nutrition, and immunity, as well as that of serum tumor markers after curative resection of pancreatic ductal adenocarcinomas (PDACs).Methods: Between 2006 and 2015, 43 patients with PDACs underwent curative resection at Tottori Prefectural Central Hospital. We analyzed which preoperative indicators (i.e., C-reactive protein/albumin ratio [CAR], neutrophil/lymphocyte ratio [NLR], prognostic nutritional index [PNI], carcinoembryonic antigen [CEA], and carbohydrate antigen 19-9 [CA 19-9]) were the most relevant risk factors for occurrence of POPF and poor patient survival.Results: POPF was detected in 8/43 (18.6%) patients. One patient died of pancreatic fistula at 2 months postoperatively. Among nine candidate factors (operative procedure, operation time, tumor stage, preoperative serum amylase, preoperative CAR, NLR, PNI, CEA, and CA 19-9), we did not identify any significant risk factor for the occurrence of POPF. The 5-year overall survival (OS) rate of the 43 patients was 22.4%, and the overall median survival time was 21 months. The multivariate OS analysis demonstrated that high CAR and low PNI were strong preoperative markers of poor prognosis independently of tumor stage.Conclusions: Preoperative CAR and PNI are useful prognostic markers for patients with operable PDACs.

Preoperative C-Reactive Protein-to-Albumin Ratio and Its Ability to Predict Outcomes of Pancreatic Cancer Resection: A Systematic Review

“…A further 14 studies were excluded, as 5 were single-arm studies, 2 evaluated postoperative values, and the remaining 7 included patients who did not have pancreatic cancer resection. Therefore, 8 retrospective comparative studies [20][21][22][23][24][25][26][27] were deemed appropriate for inclusion (Figure 1). The included studies reported a total of 1056 patients undergoing pancreatic cancer resection, of whom 378 belonged to the high CAR group and the remaining 678 belonged to the low CAR group.…”

“…Although the use of neoadjuvant chemotherapy was comparable between the high and low CAR groups in each study, there was significant heterogeneity among the included studies. Murakawa et al [22] and Ikeguchi et al [25] reported no use of neoadjuvant chemotherapy in their included patients. Oshima et al [20] reported the use of neoadjuvant chemotherapy in all patients included.…”

“…Neoadjuvant chemotherapy. Five studies [20][21][22]24,25] provided information about the use of neoadjuvant chemotherapy in their high and low CAR groups. Although the use of neoadjuvant chemotherapy was comparable between the high and low CAR groups in each study, there was significant heterogeneity among the included studies.…”

“…Four studies [22,24,25,27] reported the pTNM staging of the included patients in the high and low CAR groups. The pTNM stages included were stage I and II in the study of Murakawa et al [22], stages I-III in the study of Ikeguchi et al [25], and stage I-IV in the studies of Ikuta et al [24] and Haruki et al [27]. In all the included studies, the patients in the high CAR group had a more advanced pTNM stage.…”

No Drain, No Problem: Serum-Based Marker Prediction of Clinically Relevant Postoperative Pancreatic Fistula

“…Elevated preoperative CAR values have been shown to be a strong, independent predictor of poor prognosis after pancreatic adenocarcinoma resection, but exceedingly few studies have assessed if CAR is a viable screening or diagnostic marker for the development of CR-POPF. 11,12 Further, only Sakamoto et al 13 has directly compared CAR to the current standard for CR-POPF screening, POD 1 DAC.…”