The preoperative indicators C-reactive/albumin ratio (CAR) and prognostic nutritional index (PNI) may be useful prognostic markers for patients with operable pancreatic ductal adenocarcinoma (PDAC), according to a study published in the Journal of Pancreatic Cancer.

The prognosis for patients with PDAC is very poor, with 5-year survival rates of 20% to 35% even in patients who undergo curative resection. Prior studies found evidence associating preoperative chronic inflammation, low immunity, and poor nutrition with poor survival.

For this retrospective study, researchers identified 43 patients with PDAC who underwent curative resection without receiving prior chemotherapy or radiation.

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Patients’ CAR, PNI, neutrophil/lymphocyte ratio (NLR), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA-19-9) levels, all potentially relevant risk factors for poor patient survival and postoperative pancreatic fistula (POPF), were calculated from blood samples taken at the time of hospital admission.

The mean follow-up period was 25.2 months. POPF occurred in 18.6% of patients, but none of the assessed preoperative markers were correlated with an increased risk of POPF.

The 5-year overall survival (OS) rate was 22.4%, and patients achieved a median survival time of 21 months.

Five-year OS in patients with low preoperative PNI was 4% vs 35% in patients with a high PNI (P =.001). A strong correlation was seen with poor 5-year OS and high preoperative CAR even though there was no statistical significance.

Preoperative low PNI and high CAR levels are strongly correlated with poor outcomes in PDAC, and the investigators conclude that “these markers should be assessed when selecting the treatment strategies for patients with PDACs”.


1. Ikeguchi M, Hanaki T, Endo K, et al. C-reactive protein/albumin ratio and prognostic nutritional index are strong prognostic indicators of survival in resected pancreatic ductal adenocarcinoma [published online July 1, 2017]. J Pancreat Cancer. doi: 10.1089/crpc.2017.0006