Skip to main content
Log in

The C-reactive Protein to Albumin Ratio Predicts Long-Term Outcomes in Patients with Pancreatic Cancer After Pancreatic Resection

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The C-reactive protein to albumin (CRP/Alb) ratio, a novel inflammation-based prognostic score, is associated with outcomes in septic patients. The prognostic value of CRP/Alb ratio has not been established in cancer patients. The aim of this study is to evaluate the significance of CRP/Alb ratio in therapeutic outcome after pancreatic resection for pancreatic cancer.

Methods

The study comprised 113 patients who had undergone pancreatic resection for pancreatic cancer between April 2001 and December 2011. We retrospectively investigated the relation between CRP/Alb ratio and disease-free as well as overall survival.

Results

The optimal cut-off level of the CRP/Alb ratio was 0.03. For disease-free survival, preoperative biliary drainage (p = 0.011), advanced tumor-node-metastasis (TNM) classification (p = 0.002), and higher CRP/Alb ratio (p = 0.049) by univariate analysis, and advanced TNM classification (p = 0.003) by multivariate analysis, were independent and significant predictors of cancer recurrence. For overall survival, preoperative biliary drainage (p = 0.012), advanced TNM classification (p = 0.001), and higher CRP/Alb ratio (p = 0.023) by univariate analysis, and advanced TNM classification (p = 0.003) and higher CRP/Alb ratio (p = 0.035) by multivariate analysis, were independent and significant predictors of poor patient outcome.

Conclusions

The CRP/Alb ratio may be an independent and significant indicator of poor long-term outcomes in patients with pancreatic cancer after pancreatic resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65:5–29

    Article  PubMed  Google Scholar 

  2. Okabayashi T, Shima Y, Iwata J et al (2014) S-1 vs. gemcitabine as an adjuvant therapy after surgical resection for ductal adenocarcinoma of the pancreas. World J Surg 38:2986–2993

    Article  PubMed  Google Scholar 

  3. Winter JM, Cameron JL, Campbell KA et al (2006) 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 10:1199–1210

    Article  PubMed  Google Scholar 

  4. van Roest MH, Gouw AS, Peeters PM et al (2008) Results of pancreaticoduodenectomy in patients with periampullary adenocarcinoma: perineural growth more important prognostic factor than tumor localization. Ann Surg 248:97–103

    Article  PubMed  Google Scholar 

  5. Jamieson NB, Denley SM, Logue J et al (2011) A prospective comparison of the prognostic value of tumor- and patient-related factors in patients undergoing potentially curative surgery for pancreatic ductal adenocarcinoma. Ann Surg Oncol 18:2318–2328

    Article  PubMed  Google Scholar 

  6. Mantovani A, Allavena P, Sica A et al (2008) Cancer-related inflammation. Nature 454:436–444

    Article  CAS  PubMed  Google Scholar 

  7. Pagès F, Galon J, Dieu-Nosjean MC et al (2010) Immune infiltration in human tumors: a prognostic factor that should not be ignored. Oncogene 29:1093–1102

    Article  PubMed  Google Scholar 

  8. Proctor MJ, Morrison DS, Talwar D et al (2011) A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow inflammation outcome study. Eur J Cancer 47:2633–2641

    Article  PubMed  Google Scholar 

  9. McMillan DC (2008) An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. Proc Nutr Soc 67:257–262

    Article  PubMed  Google Scholar 

  10. La Torre M, Nigri G, Cavallini M et al (2012) The glasgow prognostic score as a predictor of survival in patients with potentially resectable pancreatic adenocarcinoma. Ann Surg Oncol 19:2917–2923

    Article  PubMed  Google Scholar 

  11. Paramanathan A, Saxena A, Morris DL (2014) A systematic review and meta-analysis on the impact of pre-operative neutrophil lymphocyte ratio on long term outcomes after curative intent resection of solid tumours. Surg Oncol 23:31–39

    Article  PubMed  Google Scholar 

  12. Stotz M, Gerger A, Eisner F et al (2013) Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer. Br J Cancer 109:416–421

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Shirai Y, Shiba H, Sakamoto T et al (2015) Preoperative platelet to lymphocyte ratio predicts outcome of patients with pancreatic ductal adenocarcinoma after pancreatic resection. Surgery 158:360–365

    Article  PubMed  Google Scholar 

  14. Fairclough E, Cairns E, Hamilton J et al (2009) Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome. Clin Med 9:30–33

    Article  Google Scholar 

  15. Ranzani OT, Zampieri FG, Forte DN et al (2013) C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS ONE 8:e59321

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kinoshita A, Onoda H, Imai N et al (2015) The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann Surg Oncol 22:803–810

    Article  PubMed  Google Scholar 

  17. Japan Pancreas Society (2009) General rules for the study of pancreatic cancer, 6th edn. Kanehara, Tokyo

    Google Scholar 

  18. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hwang JC, Jiang MY, Lu YH et al (2015) Precedent fluctuation of serum hs-CRP to albumin ratios and mortality risk of clinically stable hemodialysis patients. PLoS One 10:e0120266

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wong VK, Malik HZ, Hamady ZZ et al (2007) C-reactive protein as a predictor of prognosis following curative resection for colorectal liver metastases. Br J Cancer 96:222–225

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Yang J, Wezeman M, Zhang X et al (2007) Human C-reactive protein binds activating Fcgamma receptors and protects myeloma tumor cells from apoptosis. Cancer Cell 12:252–265

    Article  PubMed  Google Scholar 

  22. Xavier P, Belo L, Beires J et al (2006) Serum levels of VEGF and TNF-alpha and their association with C-reactive protein in patients with endometriosis. Arch Gynecol Obstet 273:227–231

    Article  CAS  PubMed  Google Scholar 

  23. Fondevila C, Metges JP, Fuster J et al (2004) p53 and VEGF expression are independent predictors of tumour recurrence and survival following curative resection of gastric cancer. Br J Cancer 90:206–215

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Canna K, McArdle PA, McMillan DC et al (2005) The relationship between tumour T-lymphocyte infiltration, the systemic inflammatory response and survival in patients undergoing curative resection for colorectal cancer. Br J Cancer 92:651–654

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Kanda M, Fujii T, Kodera Y et al (2011) Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg 98:268–274

    Article  CAS  PubMed  Google Scholar 

  26. Okumura S, Kaido T, Hamaguchi Y et al (2015) Impact of preoperative quality as well as quantity of skeletal muscle on survival after resection of pancreatic cancer. Surgery 157:1088–1098

    Article  PubMed  Google Scholar 

  27. Bozzetti F, Mariani L (2014) Perioperative nutritional support of patients undergoing pancreatic surgery in the age of ERAS. Nutrition 30:1267–1271

    Article  PubMed  Google Scholar 

  28. Giger U, Büchler M, Farhadi J et al (2007) Preoperative immunonutrition suppresses perioperative inflammatory response in patients with major abdominal surgery-a randomized controlled pilot study. Ann Surg Oncol 14:2798–2806

    Article  PubMed  Google Scholar 

  29. Mocellin MC, Camargo CQ, Nunes EA et al (2015) A systematic review and meta-analysis of the n-3 polyunsaturated fatty acids effects on inflammatory markers in colorectal cancer. Clin Nutr. doi:10.1016/j.clnu.2015.04.013

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Koichiro Haruki.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Haruki, K., Shiba, H., Shirai, Y. et al. The C-reactive Protein to Albumin Ratio Predicts Long-Term Outcomes in Patients with Pancreatic Cancer After Pancreatic Resection. World J Surg 40, 2254–2260 (2016). https://doi.org/10.1007/s00268-016-3491-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-016-3491-4

Keywords

Navigation