Guo Yu, Dou Yibo, Ma Xi, Li Zhifei, Li Haorui, Sun Xugang, Gao Chuntao, Liang Yuexiang, Zhao Tiansuo
Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, PR China.
Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, PR China; Department of Hepatobiliary-Pancreatic-Splenic Surgery, Inner Mongolia Autonomous Region People's Hospital, Hohhot, China.
J Surg Res. 2025 Feb;306:543-553. doi: 10.1016/j.jss.2024.12.047. Epub 2025 Jan 30.
To clarify the prognostic significance of the C-reactive protein to prealbumin ratio (CRP or PALB) in patients with pancreatic cancer after radical resection.
A total of 432 patients with pathologically confirmed pancreatic ductal adenocarcinoma were enrolled in this retrospective study. The predictive capacity of various inflammatory indices was analyzed and compared using the area under the time-dependent receiver operating characteristic curve, including CRP or PALB, CRP-to-albumin ratio, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio. The univariate and multivariate Cox hazard models were employed to analyze the effects of CRP or PALB on overall survival (OS) and recurrence-free survival (RFS).
The optimal cut-off value for preoperative CRP or PALB was 5.94, which was derived from the receiver operating characteristic curve. In comparison with traditional inflammatory indices, CRP or PALB had the highest area under the time-dependent receiver operating characteristic curve (0.693 for 3-y OS, 0.664 for 3-y RFS, 0.662 for 5-y OS, and 0.670 for 5-y RFS), all with P < 0.05. However, when compared with neutrophil-to-lymphocyte ratio, the predictive power of CRP or PALB was not significant for 3-y RFS (P = 0.085). Based on the results of the univariate and multivariate survival analyses, patients in the high CRP or PALB group (HCP: CRP or PALB >5.94) exhibited significantly poorer OS and RFS (median OS: 20.0 versus. 38.0 mo, P = 0.003; median RFS: 10.0 versus. 22.0 mo, P < 0.001) than those in the low CRP or PALB group (CRP or PALB ≤5.94). The multivariate analysis indicated that the HCP was independently associated with poor OS (hazard ratio (HR): 1.556, 95% confidence interval (CI) [1.089-2.222], P = 0.015) and RFS (HR: 1.551, 95% CI [1.135-2.119], P = 0.006).
The predictive capacity of preoperative CRP or PALB in pancreatic ductal adenocarcinoma patients exceeds that of traditional inflammatory indices. HCP levels are significantly correlated with a poor prognosis.
阐明C反应蛋白与前白蛋白比值（CRP/PALB）在胰腺癌根治性切除术后患者中的预后意义。
本回顾性研究共纳入432例经病理证实的胰腺导管腺癌患者。使用时间依赖性受试者工作特征曲线下面积分析和比较各种炎症指标的预测能力，包括CRP/PALB、CRP与白蛋白比值、中性粒细胞与淋巴细胞比值以及血小板与淋巴细胞比值。采用单因素和多因素Cox风险模型分析CRP/PALB对总生存期（OS）和无复发生存期（RFS）的影响。
术前CRP/PALB的最佳截断值为5.94，由受试者工作特征曲线得出。与传统炎症指标相比，CRP/PALB在时间依赖性受试者工作特征曲线下面积最高（3年OS为0.693，3年RFS为0.664，5年OS为0.662，5年RFS为0.670），均P<0.05。然而，与中性粒细胞与淋巴细胞比值相比，CRP/PALB对3年RFS的预测能力不显著（P=0.085）。基于单因素和多因素生存分析结果，高CRP/PALB组（HCP：CRP/PALB>5.94）患者的OS和RFS明显低于低CRP/PALB组（CRP/PALB≤5.94）（中位OS：20.0对38.0个月，P=0.003；中位RFS：10.0对22.0个月，P<0.001）。多因素分析表明，HCP与不良OS（风险比（HR）：1.556，95%置信区间（CI）[1.089-2.222]，P=0.015）和RFS（HR：1.551，95%CI[1.135-2.119]，P=0.006）独立相关。
术前CRP/PALB在胰腺导管腺癌患者中的预测能力超过传统炎症指标。HCP水平与不良预后显著相关。
