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

  • Translational Research and Biomarkers
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (Grant Nos. 81625016, 81871940, 81902417), the Shanghai Natural Science Foundation (Grant No. 17ZR1406300), the Shanghai Cancer Center Foundation for Distinguished Young Scholars (Grant No. YJJQ201803), and the Fudan University Personalized Project for “Double Top” Original Research (Grant No. XM03190633).

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Author notes

  1. Zhiyao Fan, Guopei Luo and Yitao Gong contributed equally to this work.

Authors and Affiliations

  1. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China

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

  2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China

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

  3. Shanghai Pancreatic Cancer Institute, Shanghai, People’s Republic of China

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

  4. Pancreatic Cancer Institute, Fudan University, Shanghai, People’s Republic of China

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

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  1. Zhiyao Fan
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Contributions

CL and XY designed the study, and ZF, YG and GL performed the statistical analysis. All authors collected the clinical data and drafted the manuscript. XY and CL critically reviewed the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Chen Liu or Xianjun Yu.

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Fig. S1

Kaplan–Meier plot of overall survival (OS) between patients with a C-reactive protein/lymphocyte ratio (CLR) higher than 1.8 and patients with a CLR of 1.8 or lower in the (a) surgical and (b) nonsurgical groups. (TIFF 665 kb)

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Fan, Z., Luo, G., Gong, Y. et al. Prognostic Value of the C-Reactive Protein/Lymphocyte Ratio in Pancreatic Cancer. Ann Surg Oncol 27, 4017–4025 (2020). https://doi.org/10.1245/s10434-020-08301-3

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  • DOI: https://doi.org/10.1245/s10434-020-08301-3

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