Prognostic Impact of Pre- and Post-operative P-CRP Levels in Pancreatic Cancer Patients

Background C-reactive protein (CRP) levels reflect ongoing inflammation and/or tissue damage, and studies suggest that platelets play a role in tumor invasion and metastasis. P-CRP is defined as the multiplied product of serum CRP and platelet levels. Here the prognostic value of pre- and post-operative P-CRP levels in pancreatic cancer (PC) patients was assessed. Methods This retrospective study used data from 107 consecutive PC patients who had undergone either pancreaticoduodenectomy or distal pancreatectomy. Clinicopathological parameters and pre/post-operative laboratory data derived from patient records were used for analyses. P-CRP was defined as the product of peripheral thrombocyte count (/uL) x serum CRP level (mg/dL) divided by 10(4); the optimal P-CRP cut-off value was defined using receiver operating characteristic curves. Results PC patients were classified as either p-CR P-Low (< 1.782; n = 49) or P-CR P-High (>= 1.782; n = 58), based on the cut-off value of 1.782. Univariate analysis revealed that performance status, clinical stage, pathological T and N stages, P-CRP, and carbohydrate antigen 19-9 (CA19-9) significantly affected overall survival (OS). Multivariate analysis revealed that independent risk factors for OS were pathological N stage, P-CRP, and CA19-9. Additionally, 103 PC patients for whom postoperative data were available were classified into four groups (P-CR PLow-Down, P-CR PLow-Up, P-CR P(High-Down )and P-CR P-H(igh)-Up), based on preoperative P-CRP and postoperative trend of P-CRP, and we found that prognosis, in terms of OS, was significantly different among these groups (P = 0.012). Conclusion Pre- and post-operative P-CRP values are a potential predictor of prognosis in PC patients.