Skip to main content
Erschienen in: Annals of Surgical Oncology 10/2020

06.03.2020 | Translational Research and Biomarkers

Prognostic Value of the C-Reactive Protein/Lymphocyte Ratio in Pancreatic Cancer

verfasst von: Zhiyao Fan, Guopei Luo, Yitao Gong, He Xu, Yunzhen Qian, Shengming Deng, Qiuyi Huang, Chao Yang, He Cheng, Kaizhou Jin, Chen Liu, Xianjun Yu

Erschienen in: Annals of Surgical Oncology | Ausgabe 10/2020

Einloggen, um Zugang zu erhalten

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.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Strobel O, Neoptolemos J, Jäger D, et al. Optimizing the outcomes of pancreatic cancer surgery. Nat Rev Clin Oncol. 2019;16:11–26.CrossRef Strobel O, Neoptolemos J, Jäger D, et al. Optimizing the outcomes of pancreatic cancer surgery. Nat Rev Clin Oncol. 2019;16:11–26.CrossRef
2.
Zurück zum Zitat Vincent A, Herman J, Schulick R, et al. Pancreatic cancer. Lancet. 2011;378:607–20.CrossRef Vincent A, Herman J, Schulick R, et al. Pancreatic cancer. Lancet. 2011;378:607–20.CrossRef
3.
Zurück zum Zitat Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30.CrossRef Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30.CrossRef
4.
Zurück zum Zitat Sidaway P. Pancreatic cancer: TCGA data reveal a highly heterogeneous disease. Nat Rev Clin Oncol. 2017;14:648.PubMed Sidaway P. Pancreatic cancer: TCGA data reveal a highly heterogeneous disease. Nat Rev Clin Oncol. 2017;14:648.PubMed
5.
Zurück zum Zitat Fahrmann JF, Bantis LE, Capello M, et al. A plasma-derived protein-metabolite multiplexed panel for early-stage pancreatic cancer. J Natl Cancer Inst. 2018;111:372–9.CrossRef Fahrmann JF, Bantis LE, Capello M, et al. A plasma-derived protein-metabolite multiplexed panel for early-stage pancreatic cancer. J Natl Cancer Inst. 2018;111:372–9.CrossRef
6.
Zurück zum Zitat Luo G, Liu C, Guo M, et al. Potential biomarkers in Lewis-negative patients with pancreatic cancer. Ann Surg. 2017;265:800–5.CrossRef Luo G, Liu C, Guo M, et al. Potential biomarkers in Lewis-negative patients with pancreatic cancer. Ann Surg. 2017;265:800–5.CrossRef
7.
Zurück zum Zitat Nahm CB, Turchini J, Jamieson N, et al. Biomarker panel predicts survival after resection in pancreatic ductal adenocarcinoma: a multi-institutional cohort study. Eur J Surg Oncol. 2018;45:218–24.CrossRef Nahm CB, Turchini J, Jamieson N, et al. Biomarker panel predicts survival after resection in pancreatic ductal adenocarcinoma: a multi-institutional cohort study. Eur J Surg Oncol. 2018;45:218–24.CrossRef
8.
Zurück zum Zitat Liu Z, Jin K, Guo M, et al. Prognostic value of the CRP/Alb ratio: a novel inflammation-based score in pancreatic cancer. Ann Surg Oncol. 2016;24:561–8.CrossRef Liu Z, Jin K, Guo M, et al. Prognostic value of the CRP/Alb ratio: a novel inflammation-based score in pancreatic cancer. Ann Surg Oncol. 2016;24:561–8.CrossRef
9.
Zurück zum Zitat 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;22:670–6.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;22:670–6.CrossRef
10.
Zurück zum Zitat Greten FR, Grivennikov SI. Inflammation and cancer: triggers, mechanisms, and consequences. Immunity. 2019;51:27–41.CrossRef Greten FR, Grivennikov SI. Inflammation and cancer: triggers, mechanisms, and consequences. Immunity. 2019;51:27–41.CrossRef
11.
Zurück zum Zitat Taniguchi K, Karin M. NF-κB, inflammation, immunity, and cancer: coming of age. Nat Rev Immunol. 2018;18:309–24.CrossRef Taniguchi K, Karin M. NF-κB, inflammation, immunity, and cancer: coming of age. Nat Rev Immunol. 2018;18:309–24.CrossRef
12.
Zurück zum Zitat Imaoka H, Mizuno N, Hara K, et al. Evaluation of modified glasgow prognostic score for pancreatic cancer: a retrospective cohort study. Pancreas. 2015;45:211–7.CrossRef Imaoka H, Mizuno N, Hara K, et al. Evaluation of modified glasgow prognostic score for pancreatic cancer: a retrospective cohort study. Pancreas. 2015;45:211–7.CrossRef
13.
Zurück zum Zitat Shaul ME, Fridlender ZG. Tumour-associated neutrophils in patients with cancer. Nat Rev Clin Oncol. 2019;16:601–20.CrossRef Shaul ME, Fridlender ZG. Tumour-associated neutrophils in patients with cancer. Nat Rev Clin Oncol. 2019;16:601–20.CrossRef
14.
Zurück zum Zitat Tomioka N, Azuma M, Ikarashi M, et al. The therapeutic candidate for immune checkpoint inhibitors elucidated by the status of tumor-infiltrating lymphocytes (TILs) and programmed death ligand 1 (PD-L1) expression in triple negative breast cancer (TNBC). Breast Cancer. 2018;25:34–42.CrossRef Tomioka N, Azuma M, Ikarashi M, et al. The therapeutic candidate for immune checkpoint inhibitors elucidated by the status of tumor-infiltrating lymphocytes (TILs) and programmed death ligand 1 (PD-L1) expression in triple negative breast cancer (TNBC). Breast Cancer. 2018;25:34–42.CrossRef
15.
Zurück zum Zitat Kuznetsov HS, Marsh T, Markens BA, et al. Identification of luminal breast cancers that establish a tumor-supportive macroenvironment defined by proangiogenic platelets and bone marrow-derived cells. Cancer Discov. 2012;2:1150–65.CrossRef Kuznetsov HS, Marsh T, Markens BA, et al. Identification of luminal breast cancers that establish a tumor-supportive macroenvironment defined by proangiogenic platelets and bone marrow-derived cells. Cancer Discov. 2012;2:1150–65.CrossRef
16.
Zurück zum Zitat Gunter MJ, Tao W, Mary C, et al. Circulating adipokines and inflammatory markers and postmenopausal breast cancer risk. J Natl Cancer Inst. 2016;107:djv169. Gunter MJ, Tao W, Mary C, et al. Circulating adipokines and inflammatory markers and postmenopausal breast cancer risk. J Natl Cancer Inst. 2016;107:djv169.
17.
Zurück zum Zitat Hooman D, Harman Maxim B, Gus M, et al. The association of preoperative serum albumin level and American Society of Anesthesiologists (ASA) score on early complications and survival of patients undergoing radical cystectomy for urothelial bladder cancer. BJU Int. 2014;113:887–93.CrossRef Hooman D, Harman Maxim B, Gus M, et al. The association of preoperative serum albumin level and American Society of Anesthesiologists (ASA) score on early complications and survival of patients undergoing radical cystectomy for urothelial bladder cancer. BJU Int. 2014;113:887–93.CrossRef
18.
Zurück zum Zitat Templeton AJ, Knox JJ, Lin X, et al. Change in neutrophil-to-lymphocyte ratio in response to targeted therapy for metastatic renal cell carcinoma as a prognosticator and biomarker of efficacy. Eur Urol. 2016;70:358–64.CrossRef Templeton AJ, Knox JJ, Lin X, et al. Change in neutrophil-to-lymphocyte ratio in response to targeted therapy for metastatic renal cell carcinoma as a prognosticator and biomarker of efficacy. Eur Urol. 2016;70:358–64.CrossRef
19.
Zurück zum Zitat Cummings M, Merone L, Keeble C, et al. Preoperative neutrophil: lymphocyte and platelet:lymphocyte ratios predict endometrial cancer survival. Br J Cancer. 2015;113:311–20.CrossRef Cummings M, Merone L, Keeble C, et al. Preoperative neutrophil: lymphocyte and platelet:lymphocyte ratios predict endometrial cancer survival. Br J Cancer. 2015;113:311–20.CrossRef
20.
Zurück zum Zitat Guo S, He X, Chen Q, et al. The C-reactive protein/albumin ratio, a validated prognostic score, predicts outcome of surgical renal cell carcinoma patients. BMC Cancer. 2017;17:171.CrossRef Guo S, He X, Chen Q, et al. The C-reactive protein/albumin ratio, a validated prognostic score, predicts outcome of surgical renal cell carcinoma patients. BMC Cancer. 2017;17:171.CrossRef
21.
Zurück zum Zitat Kawai M, Hirono S, Okada KI, et al. Low lymphocyte-monocyte ratio after neoadjuvant therapy predicts poor survival after pancreatectomy in patients with borderline resectable pancreatic cancer. Surgery. 2019;165:1151–60.CrossRef Kawai M, Hirono S, Okada KI, et al. Low lymphocyte-monocyte ratio after neoadjuvant therapy predicts poor survival after pancreatectomy in patients with borderline resectable pancreatic cancer. Surgery. 2019;165:1151–60.CrossRef
22.
Zurück zum Zitat Chun YS, Pawlik TM, Vauthey JN. 8th Edition of the AJCC cancer staging manual: pancreas and hepatobiliary cancers. Ann Surg Oncol. 2018;25:845–7.CrossRef Chun YS, Pawlik TM, Vauthey JN. 8th Edition of the AJCC cancer staging manual: pancreas and hepatobiliary cancers. Ann Surg Oncol. 2018;25:845–7.CrossRef
23.
Zurück zum Zitat Jones SA, Jenkins BJ. Recent insights into targeting the IL-6 cytokine family in inflammatory diseases and cancer. Nat Rev Immunol. 2018;18:773–89.CrossRef Jones SA, Jenkins BJ. Recent insights into targeting the IL-6 cytokine family in inflammatory diseases and cancer. Nat Rev Immunol. 2018;18:773–89.CrossRef
24.
Zurück zum Zitat Crusz SM, Balkwill FR. Inflammation and cancer: advances and new agents. Nat Rev Clin Oncol. 2015;12:584–96.CrossRef Crusz SM, Balkwill FR. Inflammation and cancer: advances and new agents. Nat Rev Clin Oncol. 2015;12:584–96.CrossRef
25.
Zurück zum Zitat Lee BM, Chung SY, Chang JS, et al. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are prognostic factors in patients with locally advanced pancreatic cancer treated with chemoradiotherapy. Gut Liver. 2018;12:342–52.CrossRef Lee BM, Chung SY, Chang JS, et al. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are prognostic factors in patients with locally advanced pancreatic cancer treated with chemoradiotherapy. Gut Liver. 2018;12:342–52.CrossRef
26.
Zurück zum Zitat Tingle SJ, Severs GR, Goodfellow M, et al. NARCA: a novel prognostic scoring system using neutrophil-albumin ratio and Ca19-9 to predict overall survival in palliative pancreatic cancer. J Surg Oncol. 2018;118:680–6.CrossRef Tingle SJ, Severs GR, Goodfellow M, et al. NARCA: a novel prognostic scoring system using neutrophil-albumin ratio and Ca19-9 to predict overall survival in palliative pancreatic cancer. J Surg Oncol. 2018;118:680–6.CrossRef
27.
Zurück zum Zitat Gershov D, Kim S, Brot N, et al. C-reactive protein binds to apoptotic cells, protects the cells from assembly of the terminal complement components, and sustains an antiinflammatory innate immune response: implications for systemic autoimmunity. J Exper Med. 2000;192:1353–64.CrossRef Gershov D, Kim S, Brot N, et al. C-reactive protein binds to apoptotic cells, protects the cells from assembly of the terminal complement components, and sustains an antiinflammatory innate immune response: implications for systemic autoimmunity. J Exper Med. 2000;192:1353–64.CrossRef
28.
Zurück zum Zitat Yao Z, Zhang Y, Wu H. Regulation of C-reactive protein conformation in inflammation. Inflamm Res. 2019;68:815–23.CrossRef Yao Z, Zhang Y, Wu H. Regulation of C-reactive protein conformation in inflammation. Inflamm Res. 2019;68:815–23.CrossRef
29.
Zurück zum Zitat Kishi T, Nakamura A, Itasaka S, et al. Pretreatment C-reactive protein level predicts outcome and patterns of failure after chemoradiotherapy for locally advanced pancreatic cancer. Pancreatology. 2015;15:694–700.CrossRef Kishi T, Nakamura A, Itasaka S, et al. Pretreatment C-reactive protein level predicts outcome and patterns of failure after chemoradiotherapy for locally advanced pancreatic cancer. Pancreatology. 2015;15:694–700.CrossRef
30.
Zurück zum Zitat Miyamoto R, Oda T, Hashimoto S, et al. Platelet × CRP multiplier value as an indicator of poor prognosis in patients with resectable pancreatic cancer. Pancreas. 2017;46:35–41.CrossRef Miyamoto R, Oda T, Hashimoto S, et al. Platelet × CRP multiplier value as an indicator of poor prognosis in patients with resectable pancreatic cancer. Pancreas. 2017;46:35–41.CrossRef
31.
Zurück zum Zitat Shirin K, Subhasis C, Chakraborty NG. Manipulation of regulatory T cells and antigen-specific cytotoxic T lymphocyte-based tumour immunotherapy. Immunology. 2015;144:186–96.CrossRef Shirin K, Subhasis C, Chakraborty NG. Manipulation of regulatory T cells and antigen-specific cytotoxic T lymphocyte-based tumour immunotherapy. Immunology. 2015;144:186–96.CrossRef
32.
Zurück zum Zitat Clark EJ, Connor S, Taylor MA, et al. Preoperative lymphocyte count as a prognostic factor in resected pancreatic ductal adenocarcinoma. HPB. 2007;9:456–60.CrossRef Clark EJ, Connor S, Taylor MA, et al. Preoperative lymphocyte count as a prognostic factor in resected pancreatic ductal adenocarcinoma. HPB. 2007;9:456–60.CrossRef
33.
Zurück zum Zitat Rho SY, Hwang HK, Chong JU, et al. Association of preoperative total lymphocyte count with prognosis in resected left-sided pancreatic cancer. ANZ J Surg. 2019;89:503–8.CrossRef Rho SY, Hwang HK, Chong JU, et al. Association of preoperative total lymphocyte count with prognosis in resected left-sided pancreatic cancer. ANZ J Surg. 2019;89:503–8.CrossRef
35.
Zurück zum Zitat Nozoe T, Kono M, Kuma S, et al. New scoring system to create a prognostic criteria in colorectal carcinoma based on serum elevation of C-reactive protein and decrease in lymphocyte in peripheral blood. JMI J Med Invest. 2019;66:264–8.CrossRef Nozoe T, Kono M, Kuma S, et al. New scoring system to create a prognostic criteria in colorectal carcinoma based on serum elevation of C-reactive protein and decrease in lymphocyte in peripheral blood. JMI J Med Invest. 2019;66:264–8.CrossRef
36.
Zurück zum Zitat Templeton AJ, Mcnamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Breast Cancer Res. 2017;19:2.CrossRef Templeton AJ, Mcnamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Breast Cancer Res. 2017;19:2.CrossRef
Metadaten
Titel
Prognostic Value of the C-Reactive Protein/Lymphocyte Ratio in Pancreatic Cancer
verfasst von
Zhiyao Fan
Guopei Luo
Yitao Gong
He Xu
Yunzhen Qian
Shengming Deng
Qiuyi Huang
Chao Yang
He Cheng
Kaizhou Jin
Chen Liu
Xianjun Yu
Publikationsdatum
06.03.2020
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 10/2020
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08301-3

Weitere Artikel der Ausgabe 10/2020

Annals of Surgical Oncology 10/2020 Zur Ausgabe

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

Was nützt die Kraniektomie bei schwerer tiefer Hirnblutung?

17.05.2024 Hirnblutung Nachrichten

Eine Studie zum Nutzen der druckentlastenden Kraniektomie nach schwerer tiefer supratentorieller Hirnblutung deutet einen Nutzen der Operation an. Für überlebende Patienten ist das dennoch nur eine bedingt gute Nachricht.

Klinikreform soll zehntausende Menschenleben retten

15.05.2024 Klinik aktuell Nachrichten

Gesundheitsminister Lauterbach hat die vom Bundeskabinett beschlossene Klinikreform verteidigt. Kritik an den Plänen kommt vom Marburger Bund. Und in den Ländern wird über den Gang zum Vermittlungsausschuss spekuliert.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.