Ikuta Shinichi, Aihara Tsukasa, Yamanaka Naoki
Department of Surgery, Meiwa Hospital, Hyogo, Japan.
Asia Pac J Clin Oncol. 2019 Oct;15(5):e109-e114. doi: 10.1111/ajco.13123. Epub 2019 Jan 10.
Systemic inflammation and nutritional status are associated with clinical outcomes of cancer patients. We investigated the prognostic value of preoperative C-reactive protein to albumin ratio (CAR) in patients with pancreatic ductal adenocarcinoma (PDA) after pancreatic resection.
One-hundred and thirty-six PDA patients who underwent pancreatic resection between January 2005 and June 2017 were retrospectively enrolled. Preoperative inflammation-based scores including CAR, modified Glasgow prognostic score (mGPS), neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, lymphocyte to monocyte ratio (LMR) and prognostic nutritional index (PNI) were evaluated as potential predictor of overall survival (OS) using Cox regression models. An optimal cutoff value for the continuous variable was estimated by receiver-operating characteristic (ROC) analysis.
Patients were categorized by CAR using a cutoff value of 0.09. High CAR was associated with advanced stage, increased mGPS and decreased LMR and PNI, but not with other factors such as tumor location, preoperative biliary drainage or preoperative chemotherapy. In univariate analysis, patients with high CAR had poor OS compared with those with low CAR (P = 0.01). Multivariate analysis indicated that high CAR was an independent predictor of poor OS (P = 0.03) in addition to advanced stage and residual tumors. The predictive ability of CAR evaluated by area under the ROC curve was consistently higher than that of other inflammation-based factors.
Preoperative CAR was an independent and superior predictor of survival after pancreatic resection in patients with PDA. [Correction added on 17 January 2019, after first online publication: In Conclusion, "in" has been corrected to "independent" for clarity.].
全身炎症反应和营养状况与癌症患者的临床结局相关。我们研究了术前C反应蛋白与白蛋白比值（CAR）对胰腺导管腺癌（PDA）患者胰腺切除术后的预后价值。
回顾性纳入2005年1月至2017年6月间接受胰腺切除术的136例PDA患者。使用Cox回归模型评估包括CAR、改良格拉斯哥预后评分（mGPS）、中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值、淋巴细胞与单核细胞比值（LMR）和预后营养指数（PNI）在内的术前炎症指标作为总生存期（OS）的潜在预测指标。通过受试者操作特征（ROC）分析估计连续变量的最佳截断值。
根据CAR将患者分为两组，截断值为0.09。高CAR与晚期、mGPS升高、LMR和PNI降低相关，但与肿瘤位置、术前胆道引流或术前化疗等其他因素无关。单因素分析显示，高CAR患者的OS低于低CAR患者（P = 0.01）。多因素分析表明，除了晚期和残留肿瘤外，高CAR是OS不良的独立预测因素（P = 0.03）。通过ROC曲线下面积评估，CAR的预测能力始终高于其他基于炎症的因素。
术前CAR是PDA患者胰腺切除术后生存的独立且更好的预测指标。[2019年1月17日首次在线发表后添加的更正：结论部分，为使表达更清晰，“in”已更正为“independent”。]
