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

Abstract

Background/Aim: Prognostic factors like the CRP-to-albumin ratio (CAR) represent potential predictors for survival of pancreatic cancer patients. We aimed to investigate the prognostic strength of the CAR for overall survival of patients with pancreatic cancer undergoing pancreatic resection. Patients and Methods: Data from a total of 202 patients with pancreatic adenocarcinoma who had undergone curative pancreatic resection were subjected to a retrospective review. Overall survival was calculated according to the Kaplan-Meier method, and multivariate Cox regression analysis was used for calculating the prognostic strength of CAR. Results: CAR was an independent prognostic factor of overall survival in univariate and multivariate Cox regression analysis. Elevated CAR was associated with a higher median value of Charlson Index, higher Union for International Cancer Control (UICC) classification and increased carcinoembryonic antigen (CEA) levels. Conclusion: CAR is a useful prognostic factor for the prediction of overall survival for patients undergoing pancreatic surgery. The impact of CAR in individual risk assessment should be evaluated in further studies. Pancreatic cancer represents three to four percent of all malignant tumors, but is responsible for approximately 6% of all cancer-related deaths in Austria. Every year, around 1,500 individuals are diagnosed with pancreatic cancer in Austria (1); pancreatic ductal adenocarcinoma (PDAC) presents in general at a median age of 70 years (2). One of the factors that contributes to this high mortality rate is the fact that most cases are detected in an advanced tumor stage. The factors that contribute to genesis of pancreatic cancer are heredity, lifestyle, smoking, alcohol usage, obesity, diabetes, chronic pancreatitis, and increased use of industrial chemical substances (3-5). Inflammatory processes have been shown to be key mediators of the development and progression of pancreatic cancer (6-8). Furthermore, there is novel evidence that intracellular accumulation in perisinusoidal cells in the liver can lead to activation of carcinogenic development in genetically predisposed individuals (8). Systemic inflammatory reactions play an important role in carcinogenesis and tumor progression (9). CAR (CRP-to-albumin ratio) is related to tumor-free survival and the overall outcome of cancer patients (10, 11), but its role in patients with pancreatic ductal adenocarcinoma (PDA) undergoing pancreatic resection has been investigated only in a few reports (12, 13). At this point, there is no inflammation-based score predicting outcome in patients with PDAC after surgical resection. Our main goal was to determine if CAR could represent a useful prognostic factor for the outcome of patients diagnosed with PDAC.

Prognostic and Clinicopathological Significance of C-Reactive Protein to Albumin Ratio in Patients With Pancreatic Cancer: A Meta-Analysis

“…Seventeen studies were excluded after full-text review for insufficient data (n = 13), recruiting overlapping patients (n = 2), not focusing on pancreatic cancer (n = 1), and lack of pretreatment CAR measurement. Finally, the meta-analysis included a total of 11 studies 14 -24 comprising 2271 patients. The baseline characteristics of the included studies are shown in Table 1.…”

“…Six studies 15,16,19,22 -24 reported the relevance of CAR and clinicopathological characteristics including sex (male vs female), tumor location (head vs body or tail), disease stage (metastasis vs locally advanced), and pN stage (N1 vs N0). As shown in Figure 4 and Table 3, the pooled data indicated that high pretreatment CAR was associated with male sex (OR = 1.38, 95% CI = 1.10-1.74, P = .006) but not tumor location (OR = 0.93, 95% CI = 0.72-1.20, P = .582), disease stage (OR = 0.70, 95% CI = 0.17-2.90, P = .623), or pN stage (OR = 1.26, 95% CI = 0.42-3.77, P = .675).…”

“…The studies were published from 2016 to 2019 from 5 countries, including Japan (n ¼ 4), 17,19,20,23 China (n ¼ 3), 15,16,22 Korea (n ¼ 2), 14,21 Italy (n ¼ 1), 18 and Austria (n ¼ 1). 24 The sample sizes ranged from 43 to 595, with a median of 188. All included studies reported the association between CAR and OS, [14][15][16][17][18][19][20][21][22][23][24] with 3 14,19,21 and 2 17,20 studies reporting the relationship between CAR and PFS and DFS, respectively.…”

“…24 The sample sizes ranged from 43 to 595, with a median of 188. All included studies reported the association between CAR and OS, [14][15][16][17][18][19][20][21][22][23][24] with 3 14,19,21 and 2 17,20 studies reporting the relationship between CAR and PFS and DFS, respectively. The CAR cutoff values ranged from 0.0003 to 3.85, with a median value of 0.18.…”

“…13 The CAR is a novel inflammation-based parameter that has been evaluated as a potential prognostic factor in pancreatic cancer. 14 -24 However, the results of previous relevant studies 14 -24 were inconsistent. To quantitatively and systematically clarify this issue, we identified relevant studies and performed a meta-analysis of the prognostic value of CAR in patients with pancreatic cancer.…”