Prognostic Value of the C-Reactive Protein/Lymphocyte Ratio in Pancreatic Cancer
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ORIGINAL ARTICLE – TRANSLATIONAL RESEARCH AND BIOMARKERS
Prognostic Value of the C-Reactive Protein/Lymphocyte Ratio in Pancreatic Cancer Zhiyao Fan1,2,3,4, Guopei Luo1,2,3,4, Yitao Gong1,2,3,4, He Xu1,2,3,4, Yunzhen Qian1,2,3,4, Shengming Deng1,2,3,4, Qiuyi Huang1,2,3,4, Chao Yang1,2,3,4, He Cheng1,2,3,4, Kaizhou Jin1,2,3,4, Chen Liu1,2,3,4, and Xianjun Yu1,2,3,4 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
ABSTRACT Background. Many inflammatory markers can be used for the prognostication of pancreatic cancer, but which combination of inflammatory factors may be the best remains unclear. This study focused on the potential feasibility of the newly discovered C-reactive protein (CRP)/lymphocyte ratio (CLR) as a prognostic biomarker for patients with pancreatic cancer. Methods. The study enrolled 997 patients with pancreatic cancer. Six combinations of inflammatory markers, namely, the neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR), the CRP/albumin ratio (CAR), the neutrophil/albumin ratio (NAR), the platelet/ albumin ratio (PAR), and CLR, were examined to
determine which combination offers the highest accuracy for predicting poor survival by receiver operating characteristic curve analysis. The prognostic value of the CLR was analyzed by uni- and multivariate analyses. Results. The newly developed CLR was more accurate than the NLR, PLR, CAR, NAR, and PAR in predicting survival. The optimal cutoff value for the CLR was calculated to be 1.8 for survival. A CLR higher than 1.8 was associated with poor survival in both the univariate (hazard ratio [HR] 2.00; P \ 0.001) and multivariate (HR 1.73; P \ 0.001) analyses. In addition, a CLR higher than 1.8 was an independent risk factor for patients with stage 2 (HR 1.85; P = 0.001), stage 3 (HR 1.83; P = 0.001), or stage 4 (HR 1.70; P \ 0.001) disease. Conclusions. Pretreatment CLR can be considered a feasible biomarker for the prognostic prediction of pancreatic cancer. An elevated CLR was an independent risk factor for poor survival, with a cutoff value of 1.8.
Zhiyao Fan, Guopei Luo and Yitao Gong contributed equally to this work.
Pancreatic cancer has one of the worst prognoses of malignant tumors, with an annual incidence near its annual mortality rate.1,2 Despite continuous improvement in surgical procedures and the development of adjuvant therapy, the long-term prognosis still is poor, with a 5-year survival rate of only 8%.3 In recent years, the incidence of pancreatic cancer has been rising, and it is expected to become the second leading cause of cancer death by 2030.3 Pancreatic cancer is a heterogeneous disease with different prognoses in different subgroups.4 In addition to the existing tumor-nod
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