Prognostic significance of pre-operative C-reactive protein and the neutrophil-lymphocyte ratio in resectable pancreatic cancer: a systematic review

Better pre-operative risk stratification may improve patient selection for pancreatic resection in pancreatic cancer. C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR) have demonstrated prognostic value in some cancers. The role of CRP and NLR in predicting outcome in pancreatic can...

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Published in:HPB (Oxford, England) Vol. 17; no. 4; p. 285
Main Authors: Stevens, Lewis, Pathak, Samir, Nunes, Quentin M, Pandanaboyana, Sanjay, Macutkiewicz, Christian, Smart, Neil, Smith, Andrew M
Format: Journal Article
Language:English
Published: England 01.04.2015
Subjects:
Biomarkers, Tumor - blood
C-Reactive Protein - analysis
Humans
Inflammation Mediators - blood
Lymphocyte Count
Lymphocytes
Neutrophils
Pancreatic Neoplasms - blood
Pancreatic Neoplasms - immunology
Pancreatic Neoplasms - mortality
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Patient Selection
Predictive Value of Tests
Prognosis
Risk Factors
ISSN:1477-2574, 1477-2574
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Abstract Better pre-operative risk stratification may improve patient selection for pancreatic resection in pancreatic cancer. C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR) have demonstrated prognostic value in some cancers. The role of CRP and NLR in predicting outcome in pancreatic cancer after curative resection is not well established. An electronic search of MEDLINE, EMBASE and CINAHL was performed to identify studies assessing survival in patients after pancreatic cancer resection with high or low pre-operative CRP or NLR. Systematic review was undertaken using the PRISMA protocol. In total, 327 studies were identified with 10 reporting on survival outcomes after a pancreatic resection in patients with high or low CRP, NLR or both. All but one paper showed a trend of lower inflammatory markers in patients with longer survival. Three studies from six showed low CRP to be independently associated with increased survival and two studies of eight showed the same for NLR. All studies were retrospective cohort studies of low to moderate quality. Inflammatory markers might prove useful guides to the management of resectable pancreatic cancer but, given the poor quality of evidence, further longitudinal studies are required before incorporating pre-operative inflammatory markers into clinical decision making.
AbstractList Better pre-operative risk stratification may improve patient selection for pancreatic resection in pancreatic cancer. C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR) have demonstrated prognostic value in some cancers. The role of CRP and NLR in predicting outcome in pancreatic cancer after curative resection is not well established.BACKGROUNDBetter pre-operative risk stratification may improve patient selection for pancreatic resection in pancreatic cancer. C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR) have demonstrated prognostic value in some cancers. The role of CRP and NLR in predicting outcome in pancreatic cancer after curative resection is not well established.An electronic search of MEDLINE, EMBASE and CINAHL was performed to identify studies assessing survival in patients after pancreatic cancer resection with high or low pre-operative CRP or NLR. Systematic review was undertaken using the PRISMA protocol.METHODSAn electronic search of MEDLINE, EMBASE and CINAHL was performed to identify studies assessing survival in patients after pancreatic cancer resection with high or low pre-operative CRP or NLR. Systematic review was undertaken using the PRISMA protocol.In total, 327 studies were identified with 10 reporting on survival outcomes after a pancreatic resection in patients with high or low CRP, NLR or both. All but one paper showed a trend of lower inflammatory markers in patients with longer survival. Three studies from six showed low CRP to be independently associated with increased survival and two studies of eight showed the same for NLR. All studies were retrospective cohort studies of low to moderate quality.RESULTSIn total, 327 studies were identified with 10 reporting on survival outcomes after a pancreatic resection in patients with high or low CRP, NLR or both. All but one paper showed a trend of lower inflammatory markers in patients with longer survival. Three studies from six showed low CRP to be independently associated with increased survival and two studies of eight showed the same for NLR. All studies were retrospective cohort studies of low to moderate quality.Inflammatory markers might prove useful guides to the management of resectable pancreatic cancer but, given the poor quality of evidence, further longitudinal studies are required before incorporating pre-operative inflammatory markers into clinical decision making.DISCUSSIONInflammatory markers might prove useful guides to the management of resectable pancreatic cancer but, given the poor quality of evidence, further longitudinal studies are required before incorporating pre-operative inflammatory markers into clinical decision making.
Better pre-operative risk stratification may improve patient selection for pancreatic resection in pancreatic cancer. C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR) have demonstrated prognostic value in some cancers. The role of CRP and NLR in predicting outcome in pancreatic cancer after curative resection is not well established. An electronic search of MEDLINE, EMBASE and CINAHL was performed to identify studies assessing survival in patients after pancreatic cancer resection with high or low pre-operative CRP or NLR. Systematic review was undertaken using the PRISMA protocol. In total, 327 studies were identified with 10 reporting on survival outcomes after a pancreatic resection in patients with high or low CRP, NLR or both. All but one paper showed a trend of lower inflammatory markers in patients with longer survival. Three studies from six showed low CRP to be independently associated with increased survival and two studies of eight showed the same for NLR. All studies were retrospective cohort studies of low to moderate quality. Inflammatory markers might prove useful guides to the management of resectable pancreatic cancer but, given the poor quality of evidence, further longitudinal studies are required before incorporating pre-operative inflammatory markers into clinical decision making.
Author Stevens, Lewis
Nunes, Quentin M
Macutkiewicz, Christian
Pandanaboyana, Sanjay
Pathak, Samir
Smart, Neil
Smith, Andrew M
Author_xml – sequence: 1
  givenname: Lewis
  surname: Stevens
  fullname: Stevens, Lewis
  organization: Department of Surgery, St James' University Hospital, Leeds, Merseyside, UK
– sequence: 2
  givenname: Samir
  surname: Pathak
  fullname: Pathak, Samir
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  givenname: Quentin M
  surname: Nunes
  fullname: Nunes, Quentin M
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  givenname: Sanjay
  surname: Pandanaboyana
  fullname: Pandanaboyana, Sanjay
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  givenname: Christian
  surname: Macutkiewicz
  fullname: Macutkiewicz, Christian
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  givenname: Neil
  surname: Smart
  fullname: Smart, Neil
– sequence: 7
  givenname: Andrew M
  surname: Smith
  fullname: Smith, Andrew M
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SubjectTerms Biomarkers, Tumor - blood
C-Reactive Protein - analysis
Humans
Inflammation Mediators - blood
Lymphocyte Count
Lymphocytes
Neutrophils
Pancreatic Neoplasms - blood
Pancreatic Neoplasms - immunology
Pancreatic Neoplasms - mortality
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Patient Selection
Predictive Value of Tests
Prognosis
Risk Factors
Title Prognostic significance of pre-operative C-reactive protein and the neutrophil-lymphocyte ratio in resectable pancreatic cancer: a systematic review
URI https://www.ncbi.nlm.nih.gov/pubmed/25431369
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