ASO Author Reflections: C-Reactive Protein/Lymphocyte Ratio as a Promising Marker for Predicting Survival in Pancreatic
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: C-Reactive Protein/Lymphocyte Ratio as a Promising Marker for Predicting Survival in Pancreatic Cancer Zhiyao Fan, MD1,2,3,4, Guopei Luo, MD, PhD1,2,3,4, Yitao Gong, MD1,2,3,4, Chen Liu, MD, PhD1,2,3,4, and Xianjun Yu, MD, PhD1,2,3,4 1
Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China; 3Shanghai Pancreatic Cancer Institute, Shanghai, People’s Republic of China; 4Pancreatic Cancer Institute, Fudan University, Shanghai, People’s Republic of China
2
PAST
PRESENT
Pancreatic cancer has one of the worst prognoses of malignant tumors, with an annual incidence near its annual mortality. Despite continuous improvement in surgical procedures and the development of adjuvant therapy, the long-term prognosis is still poor, with a 5-year survival rate of only 8%.1 Many studies have reported that pretreatment inflammatory markers, such as the modified Glasgow Prognostic Score (mGPS), neutrophils, lymphocytes, platelets, C-reactive protein (CRP), albumin, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and CRP/albumin ratio (CAR), can be used to assess the prognosis of pancreatic cancer.2 While there is growing evidence indicating the prognostic value of inflammatory markers in pancreatic cancer, the combination that may best predict the oncological outcomes of patients with pancreatic cancer is still unclear. In addition, there is a lack of consensus on the critical threshold for each marker to predict the prognosis of pancreatic cancer.
In this study, a total of 997 patients with pancreatic cancer were enrolled. Six combinations of inflammatory markers, namely NLR, PLR, CAR, neutrophil/albumin ratio (NAR), platelet/albumin ratio (PAR), and CRP/lymphocyte ratio (CLR), were examined to determine which combination offers the highest accuracy for predicting poor survival by receiver operating characteristic curve analysis. The CLR, a novel inflammation-based score, was more accurate than the NLR, PLR, CAR, NAR, and PAR in predicting survival. The optimal cut-off value for the CLR was calculated to be 1.8 for survival. A CLR [ 1.8 was associated with poor survival in both univariate and multivariate analyses, and was also an independent risk factor in patients with stage II, III, or IV disease. Although retrospective, this study suggested that pretreatment CLR can be considered a feasible biomarker for the prognostic prediction of pancreatic cancer.3 FUTURE
Zhiyao Fan, Guopei Luo and Yitao Gong have contributed equally to this work. Ó Society of Surgical Oncology 2020 First Received: 26 February 2020 C. Liu, MD, PhD e-mail: [email protected] X. Yu, MD, PhD e-mail: [email protected]; [email protected]
Increasing studies have shown that the occurrence and development of cancer is closely related to the systemic and local inflammatory response of the host.4 Many inflammatory factors p
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