Skip to main content
Top
Published in: Annals of Surgical Oncology 2/2017

01-02-2017 | Pancreatic Tumors

Prognostic Value of the CRP/Alb Ratio, a Novel Inflammation-Based Score in Pancreatic Cancer

Authors: Zuqiang Liu, MD, Kaizhou Jin, MD, Meng Guo, PhD, Jiang Long, MD, Liang Liu, MD, Chen Liu, MD, Jin Xu, MD, Quanxing Ni, MD, Guopei Luo, MD, PhD, Xianjun Yu, MD, PhD

Published in: Annals of Surgical Oncology | Issue 2/2017

Login to get access

Abstract

Background

The C-reactive protein/albumin (CRP/Alb) ratio is associated with outcome in septic patients. However, as an inflammation-based score, its prognostic value for cancer has scarcely been investigated.

Methods

Between February 2010 and January 2015, we enrolled 386 patients with pancreatic ductal adenocarcinoma. Univariate and multivariate survival analysis between the groups were evaluated. Receiver operating characteristics curves were generated and areas under the curve (AUC) were compared to evaluate the discriminatory ability of the inflammation-based prognostic scoring systems, including CRP/Alb ratio, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and modified Glasgow prognostic score (mGPS).

Results

The optimal cutoff level of the CRP/Alb ratio was defined as 0.180. The prognosis of patients with CRP/Alb ratio ≥0.180 was significantly worse than CRP/Alb ratio <0.180 in univariate analysis (p < 0.001). In multivariate analysis, the CRP/Alb ratio was still associated with overall survival (p < 0.001). In addition, the CRP/Alb ratio had significantly higher AUC values compared with PLR (6, 12, and 24 months: p < 0.001, 0.017, 0.012) and mGPS (6, 12, and 24 months: p = 0.002, 0.020, 0.046) and had similar AUC values to NLR (6, 12, and 24 months: p = 0.052, 0.139, 0.041).

Conclusions

The current study demonstrated the CRP/Alb ratio may serve as a significant and promising inflammatory prognostic score in pancreatic cancer. An elevated CRP/Alb ratio is an independent factor for poor prognosis with the cutoff value of 0.180.
Literature
1.
go back to reference Liu Z, Luo G, Guo M, et al. Lymph node status predicts the benefit of adjuvant chemoradiotherapy for patients with resected pancreatic cancer. Pancreatology. 2015;3:253–8.CrossRef Liu Z, Luo G, Guo M, et al. Lymph node status predicts the benefit of adjuvant chemoradiotherapy for patients with resected pancreatic cancer. Pancreatology. 2015;3:253–8.CrossRef
2.
go back to reference Luo G, Guo M, Liu Z, et al. Blood neutrophil–lymphocyte ratio predicts survival in patients with advanced pancreatic cancer treated with chemotherapy. Ann Surg Oncol. 2015;2:670–6.CrossRef Luo G, Guo M, Liu Z, et al. Blood neutrophil–lymphocyte ratio predicts survival in patients with advanced pancreatic cancer treated with chemotherapy. Ann Surg Oncol. 2015;2:670–6.CrossRef
3.
go back to reference Lee S, Oh SY, Kim SH, et al. Prognostic significance of neutrophil lymphocyte ratio and platelet lymphocyte ratio in advanced gastric cancer patients treated with FOLFOX chemotherapy. BMC Cancer. 2013. doi:10.1186/1471-2407-13-350 Lee S, Oh SY, Kim SH, et al. Prognostic significance of neutrophil lymphocyte ratio and platelet lymphocyte ratio in advanced gastric cancer patients treated with FOLFOX chemotherapy. BMC Cancer. 2013. doi:10.​1186/​1471-2407-13-350
4.
go back to reference Absenger G, Szkandera J, Pichler M, et al. A derived neutrophil to lymphocyte ratio predicts clinical outcome in Stage II and III colon cancer patients. Br J Cancer. 2013;2:395–400.CrossRef Absenger G, Szkandera J, Pichler M, et al. A derived neutrophil to lymphocyte ratio predicts clinical outcome in Stage II and III colon cancer patients. Br J Cancer. 2013;2:395–400.CrossRef
5.
go back to reference Proctor MJ, McMillan DC, Morrison DS, Fletcher CD, Horgan PG, Clarke SJ. A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. Br J Cancer. 2012;4:695–9.CrossRef Proctor MJ, McMillan DC, Morrison DS, Fletcher CD, Horgan PG, Clarke SJ. A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. Br J Cancer. 2012;4:695–9.CrossRef
6.
7.
go back to reference Kinoshita A, Onoda H, Imai N, et al. Comparison of the prognostic value of inflammation-based prognostic scores in patients with hepatocellular carcinoma. Br J Cancer. 2012;6:988–93.CrossRef Kinoshita A, Onoda H, Imai N, et al. Comparison of the prognostic value of inflammation-based prognostic scores in patients with hepatocellular carcinoma. Br J Cancer. 2012;6:988–93.CrossRef
8.
go back to reference Inoue D, Ozaka M, Matsuyama M, et al. Prognostic value of neutrophil–lymphocyte ratio and level of C-reactive protein in a large cohort of pancreatic cancer patients: a retrospective study in a single institute in Japan. Jpn J Clin Oncol. 2015;1:61–6.CrossRef Inoue D, Ozaka M, Matsuyama M, et al. Prognostic value of neutrophil–lymphocyte ratio and level of C-reactive protein in a large cohort of pancreatic cancer patients: a retrospective study in a single institute in Japan. Jpn J Clin Oncol. 2015;1:61–6.CrossRef
9.
go back to reference Hashimoto K, Ikeda Y, Korenaga D, et al. The impact of preoperative serum C-reactive protein on the prognosis of patients with hepatocellular carcinoma. Cancer Am Cancer Soc. 2005;9:1856–64. Hashimoto K, Ikeda Y, Korenaga D, et al. The impact of preoperative serum C-reactive protein on the prognosis of patients with hepatocellular carcinoma. Cancer Am Cancer Soc. 2005;9:1856–64.
10.
go back to reference Morrison L, Laukkanen JA, Ronkainen K, Kurl S, Kauhanen J, Toriola AT. Inflammatory biomarker score and cancer: a population-based prospective cohort study. BMC Cancer. 2015. doi:10.1186/s12885-016-2115-6. Morrison L, Laukkanen JA, Ronkainen K, Kurl S, Kauhanen J, Toriola AT. Inflammatory biomarker score and cancer: a population-based prospective cohort study. BMC Cancer. 2015. doi:10.​1186/​s12885-016-2115-6.
11.
go back to reference Karakiewicz PI, Hutterer GC, Trinh QD, et al. C-reactive protein is an informative predictor of renal cell carcinoma-specific mortality: a European study of 313 patients. Cancer Am Cancer Soc. 2007;6:1241–7. Karakiewicz PI, Hutterer GC, Trinh QD, et al. C-reactive protein is an informative predictor of renal cell carcinoma-specific mortality: a European study of 313 patients. Cancer Am Cancer Soc. 2007;6:1241–7.
12.
go back to reference McMillan DC. The systemic inflammation-based Glasgow prognostic score: a decade of experience in patients with cancer. Cancer Treat Rev. 2013;5:534–40.CrossRef McMillan DC. The systemic inflammation-based Glasgow prognostic score: a decade of experience in patients with cancer. Cancer Treat Rev. 2013;5:534–40.CrossRef
13.
go back to reference Fairclough E, Cairns E, Hamilton J, Kelly C. 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 (Lond). 2009;1:30–3.CrossRef Fairclough E, Cairns E, Hamilton J, Kelly C. 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 (Lond). 2009;1:30–3.CrossRef
15.
go back to reference Kinoshita A, Onoda H, Imai N, et al. The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann Surg Oncol. 2015;3:803–10.CrossRef Kinoshita A, Onoda H, Imai N, et al. The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann Surg Oncol. 2015;3:803–10.CrossRef
16.
go back to reference Xu XL, Yu HQ, Hu W, Song Q, Mao WM. A novel inflammation-based prognostic score, the C-reactive protein/albumin ratio predicts the prognosis of patients with operable esophageal squamous cell carcinoma. PLoS One. 2015;9:e138657. doi:10.1371/journal.pone.0138657 Xu XL, Yu HQ, Hu W, Song Q, Mao WM. A novel inflammation-based prognostic score, the C-reactive protein/albumin ratio predicts the prognosis of patients with operable esophageal squamous cell carcinoma. PLoS One. 2015;9:e138657. doi:10.​1371/​journal.​pone.​0138657
18.
go back to reference Aliustaoglu M, Bilici A, Seker M, et al. The association of pre-treatment peripheral blood markers with survival in patients with pancreatic cancer. Hepatogastroenterology. 2010;99–100:640–5. Aliustaoglu M, Bilici A, Seker M, et al. The association of pre-treatment peripheral blood markers with survival in patients with pancreatic cancer. Hepatogastroenterology. 2010;99–100:640–5.
19.
go back to reference Ino Y, Yamazaki-Itoh R, Shimada K, et al. Immune cell infiltration as an indicator of the immune microenvironment of pancreatic cancer. Br J Cancer. 2013;4:914–23.CrossRef Ino Y, Yamazaki-Itoh R, Shimada K, et al. Immune cell infiltration as an indicator of the immune microenvironment of pancreatic cancer. Br J Cancer. 2013;4:914–23.CrossRef
20.
go back to reference Elinav E, Nowarski R, Thaiss CA, Hu B, Jin C, Flavell RA. Inflammation-induced cancer: crosstalk between tumours, immune cells and microorganisms. Nat Rev Cancer. 2013;11:759–71.CrossRef Elinav E, Nowarski R, Thaiss CA, Hu B, Jin C, Flavell RA. Inflammation-induced cancer: crosstalk between tumours, immune cells and microorganisms. Nat Rev Cancer. 2013;11:759–71.CrossRef
21.
go back to reference Roxburgh CS, McMillan DC. Cancer and systemic inflammation: treat the tumour and treat the host. Br J Cancer. 2014;6:1409–12.CrossRef Roxburgh CS, McMillan DC. Cancer and systemic inflammation: treat the tumour and treat the host. Br J Cancer. 2014;6:1409–12.CrossRef
22.
go back to reference Park EJ, Lee JH, Yu GY, et al. Dietary and genetic obesity promote liver inflammation and tumorigenesis by enhancing IL-6 and TNF expression. Cell. 2010;2:197–208.CrossRef Park EJ, Lee JH, Yu GY, et al. Dietary and genetic obesity promote liver inflammation and tumorigenesis by enhancing IL-6 and TNF expression. Cell. 2010;2:197–208.CrossRef
23.
go back to reference Wei XL, Wang FH, Zhang DS, et al. A novel inflammation-based prognostic score in esophageal squamous cell carcinoma: the C-reactive protein/albumin ratio. BMC Cancer. 2015. doi:10.1186/s12885-015-1379-6. Wei XL, Wang FH, Zhang DS, et al. A novel inflammation-based prognostic score in esophageal squamous cell carcinoma: the C-reactive protein/albumin ratio. BMC Cancer. 2015. doi:10.​1186/​s12885-015-1379-6.
24.
go back to reference Camp RL, Dolled-Filhart M, Rimm DL. X-Tile: a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization. Clin Cancer Res. 2004;21:7252–9.CrossRef Camp RL, Dolled-Filhart M, Rimm DL. X-Tile: a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization. Clin Cancer Res. 2004;21:7252–9.CrossRef
Metadata
Title
Prognostic Value of the CRP/Alb Ratio, a Novel Inflammation-Based Score in Pancreatic Cancer
Authors
Zuqiang Liu, MD
Kaizhou Jin, MD
Meng Guo, PhD
Jiang Long, MD
Liang Liu, MD
Chen Liu, MD
Jin Xu, MD
Quanxing Ni, MD
Guopei Luo, MD, PhD
Xianjun Yu, MD, PhD
Publication date
01-02-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5579-3

Other articles of this Issue 2/2017

Annals of Surgical Oncology 2/2017 Go to the issue