Usefulness of serum creatinine and cystatin C ratio as a screening tool for predicting prognosis in patients with pancreatic cancer

Tsukagoshi, Mariko; Watanabe, Akira; Araki, Kenichiro; Ishii, Norihiro; Hagiwara, Kaoru; Hoshino, Kouki; Muranushi, Ryo; Harimoto, Norifumi; Takizawa, Makiko; Shirabe, Ken

doi:10.1002/ags3.12671

Cited by 5 publications

(3 citation statements)

References 31 publications

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“…Previous studies have also shown that the Cr/CysC ratio is a surrogate marker for malignancy, along with sarcopenia being a poor prognostic factor for malignant disease. We have shown that Cr/CysC ratio is a useful surrogate marker in hepatocellular carcinoma and in pancreatic cancer patients undergoing surgery [12,13]. However, the usefulness of the Cr/CysC ratio in patients with biliary tract cancer has not been reported.…”

Section: Introductionmentioning

confidence: 95%

“…Harimoto et al revealed that the Cr/CysC ratio had potential as a surrogate marker in patients with hepatocellular carcinoma undergoing hepatic resection[12]. Tsukagoshi et al also showed that the Cr/CysC ratio could be a useful screening tool for predicting prognosis in pancreatic cancer patients[13]. Many of these previous studies concluded that the Cr/CysC ratio could predict prognosis because of the relationship with decreased muscle mass (in other words, sarcopenia).…”

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confidence: 99%

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Impact of the serum creatinine and cystatin C ratio for prediction of sarcopenia and prognosis in biliary tract cancer

Fukushima,

Harimoto,

Okuyama

et al. 2024

Int J Clin Oncol

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BackgroundSarcopenia is a poor prognostic factor in cancer patients. In recent years, there have been reports that serum creatinine and cystatin C (Cr/CysC) ratio is associated with sarcopenia. However, the prognostic value of the Cr/CysC ratio in biliary tract cancer is unclear. We evaluated the impact of the Cr/CysC ratio on sarcopenia and prognosis in biliary tract cancer. MethodsWe retrospectively reviewed the records of 190 patients with biliary tract cancer who had undergone surgical resection from January 2017 to March 2023. Frozen serum samples collected at the time of surgery were used to measure CysC. We calculated the Cr/CysC ratio and investigated the relationship with sarcopenia and the prognostic signi cance. ResultsSerum Cr/CysC ratio was statistically related to both skeletal muscle index and handgrip strength, both of which are diagnostic criteria for sarcopenia (skeletal muscle index: R 2 = 0.096, p < 0.001, handgrip strength: R 2 = 0.20, p < 0.001). The optimal cutoff value of the Cr/CysC ratio for sarcopenia was 0.848.The low Cr/CysC ratio group was signi cantly associated with higher preoperative CRP and lower albumin, lower skeletal muscle index, lower handgrip strength, and higher intramuscular adipose tissue content. In multivariate analysis, patients with a low Cr/CysC ratio showed poorer overall survival (hazard ratio 2.60, 95% con dence interval 1.07-6.29, p = 0.033), which was signi cantly worse than in those with a high Cr/CysC ratio. ConclusionsThe Cr/CysC ratio could be used as a marker to evaluate sarcopenia in patients with biliary tract cancer. Moreover, a low Cr/CysC ratio predicts poor prognosis in biliary tract cancer patients.

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confidence: 95%

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Impact of the serum creatinine and cystatin C ratio for prediction of sarcopenia and prognosis in biliary tract cancer

Fukushima,

Harimoto,

Okuyama

et al. 2024

Int J Clin Oncol

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“…Leveraging the characteristics of creatinine and Cystatin C, the creatinine-to-cystatin C ratio (CCR) was initially proposed by Kashani et al as a simplified method for diagnosing sarcopenia in patients (6). Since then, CCR has been extensively studied and established as a biomarker for the prognosis in patients with critically illness (7,8), hypertension (9), type 2 diabetes (10, 11) and cancer (12)(13)(14)(15)(16)(17). Recently, a retrospective study reported that low CCR was an independent biomarker of poor prognosis in nonsmall cell lung cancer (NSCLC) patients treated with PD-1 monotherapy (18).…”

Section: Introductionmentioning

confidence: 99%

Creatinine-to-cystatin C ratio and body composition predict response to PD-1 inhibitors-based combination treatment in metastatic gastric cancer

Ji,

Liu,

Jin

et al. 2024

Front. Immunol.

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BackgroundCreatinine-to-cystatin C ratio (CCR) and body composition (BC) parameters have emerged as significant prognostic factors in cancer patients. However, the potential effects of CCR in gastric cancer (GC) remains to be elucidated. This multi-center retrospective study explored the predictive and prognostic value of CCR and BC-parameters in patients with metastatic GC receiving PD-1 inhibitors-based combination therapy.MethodsOne hundred and thirteen GC patients undergoing PD-1 inhibitors-based combination therapy were enrolled at three academic medical centers from January 2021 to July 2023. A deep-learning platform based on U-Net was developed to automatically segment skeletal muscle index (SMI), subcutaneous adipose tissue index (SATI) and visceral adipose tissue index (VATI). Patients were divided into two groups based on the median of CCR or the upper tertile of BC-parameters. Logistic and Cox regression analysis were used to determine the effect of CCR and BC-parameters in predicting response rates and survival rates.ResultsThe CCR was positively correlated with SMI (r=0.43; P<0.001), but not with SATI or VATI (P>0.05). Multivariable logistic analysis identified that both low CCR (OR=0.423, P=0.066 for ORR; OR=0.026, P=0.005 for DCR) and low SATI (OR=0.270, P=0.020 for ORR; OR=0.149, P=0.056 for DCR) were independently associated with worse objective response rate (ORR) and disease control rate (DCR). Patients with low CCR or low SATI had significantly lower 8-month progression-free survival (PFS) rate and 16-month overall survival (OS) rate than those with high CCR (PFS rate, 37.6% vs. 55.1%, P=0.011; OS rate, 19.4% vs. 44.9%, P=0.002) or those with high SATI (PFS rate, 37.2% vs. 53.8%, P=0.035; OS rate, 8.0% vs. 36.0%, P<0.001). Multivariate Cox analysis showed that low CCR (HR=2.395, 95% CI: 1.234-4.648, P=0.010 for PFS rate; HR=2.528, 95% CI: 1.317-4.854, P=0.005 for OS rate) and low SATI (HR=2.188, 95% CI: 1.050-4.560, P=0.037 for PFS rate; HR=2.818, 95% CI: 1.381-5.752, P=0.004 for OS rate) were both independent prognostic factors of poor 8-month PFS rate and 16-month OS rate. A nomogram based on CCR and BC-parameters showed a good performance in predicting the 12- and 16-month OS, with a concordance index of 0.756 (95% CI, 0.722-0.789).ConclusionsLow pre-treatment CCR and SATI were independently associated with lower response rates and worse survival in patients with metastatic GC receiving PD-1 inhibitors-based combination therapy.

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Combined effect of frailty and sarcopenia on postoperative complications in older adults undergoing curative surgery for hepato‐biliary‐pancreatic cancer

Harimoto,

Sugimachi,

Nishijima

et al. 2024

Annals of Gastroent Surgery

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AimOlder adults with cancer are often at increased risk for postoperative complications following major surgeries. This study aimed to evaluate the combined role of frailty and sarcopenia in predicting postoperative complications in older adults with hepatobiliary and pancreatic cancer undergoing surgery.MethodsThis retrospective study included 107 Japanese patients who underwent comprehensive geriatric assessment (CGA) at the geriatric oncology service before cancer treatment decisions and subsequent curative surgery for hepatobiliary and pancreatic cancer. Frailty status was measured using the validated 10‐item frailty index based on a CGA (FI‐CGA‐10) and categorized as fit, prefrail, or frail. Sarcopenia was assessed using bioelectrical impedance analysis and grip strength. The primary outcome was postoperative complications, defined as Clavien–Dindo grade ≥ III, within 1 month of surgery.ResultsThe median age of the 107 patients was 79 (range, 75–89) years. Patients were categorized as fit (n = 36, 33.7%), prefrail (n = 57, 53.2%), or frail (n = 14, 13.1%). Of these, 21 patients (20%) were diagnosed with sarcopenia; 16 patients (15%) experienced postoperative complications. Patients classified as prefrail or frail had a higher incidence of postoperative complications compared with those classified as fit (19.7% vs. 5.6%, p = 0.08). Patients with both prefrail or frail and sarcopenia had a significantly higher risk of postoperative complications. This association remained significant in the multivariable model (OR 4.74; 95% CI, 1.10–20.29; p = 0.04).ConclusionIn this study, patients classified as prefrail/frail and sarcopenic were at significantly higher risk for postoperative complications.

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Usefulness of serum creatinine and cystatin C ratio as a screening tool for predicting prognosis in patients with pancreatic cancer

Cited by 5 publications

References 31 publications

Impact of the serum creatinine and cystatin C ratio for prediction of sarcopenia and prognosis in biliary tract cancer

Impact of the serum creatinine and cystatin C ratio for prediction of sarcopenia and prognosis in biliary tract cancer

Creatinine-to-cystatin C ratio and body composition predict response to PD-1 inhibitors-based combination treatment in metastatic gastric cancer

Combined effect of frailty and sarcopenia on postoperative complications in older adults undergoing curative surgery for hepato‐biliary‐pancreatic cancer

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