Abstract
BackgroundEmerging evidence indicates that an elevated C-reactive protein-to-albumin ratio (CAR) may be associated with a poor prognosis in pancreatic ductal adenocarcinoma (PDAC). Further evidence showing that this ratio has significant prognostic value could contribute to current prediction models and clinical decision-making.MethodsData were analysed of consecutive patients who underwent curative pancreatic resection between 2013 and 2018 and were histologically diagnosed with PDAC. We investigated the relation between the ultimate preoperative CAR and overall survival.ResultsA total of 163 patients were analysed. Median overall survival was 18 months (IQR 9–36). Multivariate analysis demonstrated that a higher CAR (HR 1.745, P = 0.004), a higher age (HR 1.062, P < 0.001), male sex (HR 1.977, P = 0.001), poor differentiation grade (HR 2.812, P < 0.001), and positive para-aortic lymph node(s) (HR 4.489, P < 0.001) were associated with a lower overall survival. Furthermore, a CAR ≥ 0.2 was associated with decreased overall survival (16 vs. 26 months, P = 0.003).ConclusionWe demonstrated that an ultimate preoperative elevated CAR is an independent indicator of decreased overall survival after resection for PDAC. The preoperative CAR may be of additional value to the current prediction models.
Highlights
Pancreatic cancer is the fourth leading cause of cancerrelated deaths worldwide, with a 5-year survival rate of 9% for all stages combined [1]
The aim of our study was to investigate the prognostic value of the ultimate preoperative C-reactive protein-to-albumin ratio (CAR) and the optimal cut-off value after resection for pancreatic ductal adenocarcinoma (PDAC) as compared with several established prognostic factors
Due to significant collinearity with C-reactive protein (CRP) and albumin, haemoglobin level was analysed separately, and stepwise Cox regression demonstrated that haemoglobin was not significantly associated with survival
Summary
Pancreatic cancer is the fourth leading cause of cancerrelated deaths worldwide, with a 5-year survival rate of 9% for all stages combined [1]. In recent years, emerging evidence has shown the potential value of a variety of systemic inflammationbased prognostic scores in pancreatic cancer [2,3,4,5,6,7]. Serum elevation of C-reactive protein (CRP), an acutephase protein, has been shown to be a prognostic indicator in a variety of neoplasms [8,9,10,11]. An elevated C-reactive protein-to-albumin ratio (CAR) or a composite score such as the modified Glasgow van Wijk et al Eur J Med Res (2020) 25:46. Emerging evidence indicates that an elevated C-reactive protein-to-albumin ratio (CAR) may be associated with a poor prognosis in pancreatic ductal adenocarcinoma (PDAC). Further evidence showing that this ratio has significant prognostic value could contribute to current prediction models and clinical decision-making
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