Stevens Lewis, Pathak Samir, Nunes Quentin M, Pandanaboyana Sanjay, Macutkiewicz Christian, Smart Neil, Smith Andrew M
Department of Surgery, St James' University Hospital, Leeds, Merseyside, UK.
HPB (Oxford). 2015 Apr;17(4):285-91. doi: 10.1111/hpb.12355. Epub 2014 Nov 27.
Better pre-operative risk stratification may improve patient selection for pancreatic resection in pancreatic cancer. C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR) have demonstrated prognostic value in some cancers. The role of CRP and NLR in predicting outcome in pancreatic cancer after curative resection is not well established.
An electronic search of MEDLINE, EMBASE and CINAHL was performed to identify studies assessing survival in patients after pancreatic cancer resection with high or low pre-operative CRP or NLR. Systematic review was undertaken using the PRISMA protocol.
In total, 327 studies were identified with 10 reporting on survival outcomes after a pancreatic resection in patients with high or low CRP, NLR or both. All but one paper showed a trend of lower inflammatory markers in patients with longer survival. Three studies from six showed low CRP to be independently associated with increased survival and two studies of eight showed the same for NLR. All studies were retrospective cohort studies of low to moderate quality.
Inflammatory markers might prove useful guides to the management of resectable pancreatic cancer but, given the poor quality of evidence, further longitudinal studies are required before incorporating pre-operative inflammatory markers into clinical decision making.
更好的术前风险分层可能会改善胰腺癌患者胰腺切除术的选择。C反应蛋白（CRP）和中性粒细胞与淋巴细胞比值（NLR）在某些癌症中已显示出预后价值。CRP和NLR在预测胰腺癌根治性切除术后结局中的作用尚未明确。
对MEDLINE、EMBASE和CINAHL进行电子检索，以确定评估术前CRP或NLR高或低的胰腺癌切除术后患者生存率的研究。使用PRISMA方案进行系统评价。
共识别出327项研究，其中10项报告了CRP、NLR或两者高或低的患者胰腺切除术后的生存结局。除一篇论文外，所有论文均显示生存时间较长的患者炎症标志物水平较低。六项研究中的三项表明低CRP与生存率增加独立相关，八项研究中的两项表明NLR情况相同。所有研究均为低至中等质量的回顾性队列研究。
炎症标志物可能是可切除胰腺癌管理的有用指导，但鉴于证据质量较差，在将术前炎症标志物纳入临床决策之前，需要进一步进行纵向研究。
