title: Preoperative serum C-reactive protein levels and post-operative lymph node ratio are important predictors of survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma.
abstract: BACKGROUND
  There is paucity of data on the prognostic value of pre-operative inflammatory response and post-operative lymph node ratio on patient survival after pancreatic-head resection for pancreatic ductal adenocarcinoma.
  
  
  OBJECTIVE
  To evaluate the role of the preoperative inflammatory response and postoperative pathology criteria to identify predictive and/or prognostic variables for pancreatic ductal adenocarcinoma.
  
  
  METHODS
  All patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma between 2002 and 2008 were reviewed retrospectively. The following impacts on patient survival were assessed: i) preoperative serum CRP levels, white cell count, neutrophil count, neutrophil/lymphocyte ratio, lymphocyte count, platelet/lymphocyte ratio; and ii) post-operative pathology criteria including lymph node status and lymph node ratio.
  
  
  RESULTS
  Fifty-one patients underwent potentially curative resection for pancreatic ductal adenocarcinoma during the study period. An elevated preoperative CRP level (greater than 3 mg/L) was found to be a significant adverse prognostic factor (P=0.015) predicting a poor survival, whereas white cell count (P=0.278), neutrophil count (P=0.850), neutrophil/lymphocyte ratio (P=0.272), platelet/lymphocyte ratio (P=0.532) and lymphocyte count (P=0.721) were not significant prognosticators at univariate analysis. Presence of metastatic lymph nodes did not adversely affect survival (P=0.050), however a raised lymph node ratio predicted poor survival at univariate analysis (P<0.001). The preoperative serum CRP level retained significance at multivariate analysis (P=0.011), together with lymph node ratio (P<0.001) and tumour size (greater than 2 cm; P=0.008).
  
  
  CONCLUSIONS
  A pre-operative elevated serum CRP level and raised post-operative lymph node ratio represent significant independent prognostic factors that predict poor prognosis in patients undergoing curative resection for pancreatic ductal adenocarcinoma. There is potential for future neo-adjuvant and adjuvant treatment strategies in pancreatic cancer to be tailored based on preoperative and postoperative factors that predict a poor survival.
authors.affiliation: Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom. sanjay.pandanaboyana@nhs.net
authors.forename: Pandanaboyana
authors.initials: P
authors.lastname: Sanjay
authors.forename: Rodrigo S
authors.initials: RS
authors.lastname: de Figueiredo
authors.forename: Heather
authors.initials: H
authors.lastname: Leaver
authors.forename: Simon
authors.initials: S
authors.lastname: Ogston
authors.forename: Christoph
authors.initials: C
authors.lastname: Kulli
authors.forename: Francesco M
authors.initials: FM
authors.lastname: Polignano
authors.forename: Iain S
authors.initials: IS
authors.lastname: Tait
mesh_terms: D000230:Adenocarcinoma / Q000276:immunology / Q000401:mortality / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D002097:C-Reactive Protein / Q000276:immunology / Q000378:metabolism*; D021441:Carcinoma, Pancreatic Ductal / Q000276:immunology / Q000401:mortality* / Q000601:surgery*; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000276:immunology / Q000401:mortality* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein