Clinical Implication of Pre-operative C-reactive Protein-Albumin Ratio as a Prognostic Factor of Patients With Pancreatic Ductal Adenocarcinoma: A Single-institutional Retrospective Study

Abstract

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.

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.…”

“…Murakawa [22] • A total of 117 patients with resectable PDAC were included who had radiacal surgery with S1 adjuvant chemotherapy.…”

Clinical Implication of Preoperative C-Reactive Protein/Albumin Ratio in Malignant Transformation of Intraductal Papillary Mucinous Neoplasm: A Propensity Score Analysis

“…Many studies have also reported that GPS plays a pivotal role in the progression of various malignancies, and is closely related to poor prognosis in patients [ 22 , 23 , 24 , 25 , 26 ]. In recent years, CAR has also been reported to have clinical implications and usefulness in many studies, including research regarding pancreatic cancer [ 27 , 28 , 29 , 30 , 31 ]. Cancer patients have chronically increased Interleukin-6 (IL-6) in the circulating blood, affecting the acute-phase proteins (APPs); positive APP corresponds to CRP, and negative APP to albumin.…”

The prognostic value of fibrinogen to albumin ratio in malignant tumor patients: A meta-analysis

“…A growing number of studies have shown an association between plasma albumin concentrations, inflammation, and tumorigenesis ( 18 , 19 ). Available evidence suggests that hypoproteinemia is strongly associated with poor quality of life in cancer patients and is associated with poor prognosis in patients with various malignancies ( 20 , 21 ). High fibrinogen and low albumin are associated with poor prognosis in cancer patients ( 12 , 22 ).…”