The Ratio of C-Reactive Protein to Albumin Is an Independent Predictor of Malignant Intraductal Papillary Mucinous Neoplasms of the Pancreas

Simone Serafini; Alberto Friziero; Cosimo Sperti; Lorenzo Vallese; Andrea Grego; Alfredo Piangerelli; Amanda Belluzzi; Lucia Moletta

doi:10.3390/jcm10102058

The Ratio of C-Reactive Protein to Albumin Is an Independent Predictor of Malignant Intraductal Papillary Mucinous Neoplasms of the Pancreas

J Clin Med. 2021 May 11;10(10):2058. doi: 10.3390/jcm10102058.

Authors

Simone Serafini¹, Alberto Friziero¹, Cosimo Sperti¹, Lorenzo Vallese², Andrea Grego¹, Alfredo Piangerelli¹, Amanda Belluzzi¹, Lucia Moletta¹

Affiliations

¹ Department of Surgery, Oncology and Gastroenterology, 3rd Surgery Clinic, University of Padua, via Giustiniani 2, 35128 Padua, Italy.
² Department of Surgery, SS. Giovanni and Paolo Hospital, Sestiere Castello 6777, 30122 Venice, Italy.

Abstract

There is growing evidence to indicate that inflammatory reactions are involved in cancer progression. The aim of this study is to assess the significance of systemic inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the ratio of C-reactive protein to albumin ratio (CAR), the prognostic nutritional index (PNI) and the modified Glasgow prognostic score (mGps) in the diagnosis and prognosis of malignant intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Data were obtained from a retrospective analysis of patients who underwent pancreatic resection for IPMNs from January 2005 to December 2015. Univariate and multivariate analyses were performed, considering preoperative inflammatory biomarkers, clinicopathological variables, and imaging features. Eighty-three patients with histologically proven IPMNs of the pancreas were included in the study, 37 cases of low-grade or intermediate dysplasia and 46 cases of high-grade dysplasia (HGD) or invasive carcinoma. Univariate analysis showed that obstructive jaundice (p = 0.02) and a CAR of >0.083 (p = 0.001) were predictors of malignancy. On multivariate analysis, only the CAR was a statistically significant independent predictor of HGD or invasive carcinoma in pancreatic IPMNs, identifying a subgroup of patients with a poor prognosis. Combining the CAR with patients' imaging findings, clinical features and tumor markers can be useful in the clinical management of IPMNs. Their value should be tested in prospective studies.

Keywords: C-reactive protein to albumin ratio; biomarker; inflammation; intraductal papillary mucinous neoplasm; modified Glasgow prognostic score; neutrophyl lymphocite ratio; pancreatic cancer; platelet-to-lymphocyte ratio.