Dynamic analysis of C-reactive protein/albumin ratio in pancreatic cancer

The C-reactive protein/albumin ratio (CAR), an inflammatory marker, is a useful biomarker for pancreatic cancer. Although disease status is not constant, many inflammatory markers are only classified at the start of treatment. Therefore, biomarker analysis that considers the changes in inflammatory markers during treatment is desirable. We aimed to investigate whether time-dependent changes in the CAR during nanoliposomal irinotecan with fluorouracil and folinic acid (NFF) administration can predict the prognosis of patients with unresectable or recurrent pancreatic cancer (urPC). CAR was measured in 150 participants of the NAPOLEON-2 study, an observational study involving patients with pancreatic cancer receiving NFF, and the patients were stratified by CAR. The CAR at NFF initiation was defined as CAR(1), while the minimum CAR before/throughout NFF administration was defined as CAR(min). Overall survival (OS) of patients in all groups was analyzed. Significant differences in OS between the CAR(1) < 0.54 and ≥ 0.54 groups and between the CAR(min) < 0.54 and ≥ 0.54 groups were observed. The OS was significantly better in the group with CAR(min)/CAR(1) < 0.5 than in the group with CAR(min)/CAR(1) ≥ 0.5. Dynamic changes in CAR were a clinically significant biomarker that considers not only the disease status at the start of treatment but also the response to treatment. CAR monitoring would help understand the disease status and thereby aid patients and physicians alike.