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The effects of systemic inflammatory response on prognosis of pancreatic ductal adenocarcinoma
Ann Hepatobiliary Pancreat Surg 2019 May;23(2):155-62
Published online May 31, 2019;
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Ali Aktekin1, Mehmet Torun1, Bala Basak Oven Ustaalioğlu2, Selvinaz Ozkara3, Ozcan Cakır4, Tolga Muftuoglu5

1General Surgery Department, 2Medical Oncology Department, 3Pathology Department, and 4Radiology Department, Haydarpasa Numune Education and Research Hospital, 5General Surgery Department, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey
Received October 22, 2018; Revised April 30, 2019; Accepted May 2, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: The aim of this study was to investigate the prognostic significance of neutrophyil–lymphocyte ratio (NLR), platelet- lymphocyte ratio (PLR), CRP and CA19-9 in patients were diagnosed with pancreatic ductal adenocarcinoma (PDAC) to better verify pre-operative risk stratification and management.
Methods: This retrospective study included data from 133 consecutive patients with PDAC, who were treated between 2013 and 2015. PDAC diagnosis was made by cytology or assumed by radiological assessment or surgical resection samples. All clinico-pathological data were retrieved from medical records at our institution. The laboratory data were obtained before any treatment modality. Dates of death were obtained from the central registry.
Results: There was a statistically significant relation between radiological staging and CA19-9 and survival (p=0.001, p=0.005) and there are significant differences in CA19-9 level between stage I and III, I and IV, II and III, and II and IV. Both CRP and CA19-9 levels were statistically significantly higher in patients with radiological lymph node metastasis than patients with N0 disease (p=0.037, p=0.026). NLR and CA19-9 levels were also higher in metastatic disease (p=0.032, p=0.007). According to Spearman’s correlation analysis, we found in all patients that there was a negative correlation between the survival time and CRP and neutrophil count (p=0.019, p=0.011).
Conclusions: Preoperative CRP, CA19-9 and NLR are simple, repeatable, inexpensive and well available marker, can give information on lymph node and solid organ metastasis and survival, give clues to prognosis and be useful in clinical staging of patients with PDAC.
Keywords : Pancreas; Adenocarcinoma; Neutrophil; Lymphocyte; CRP


November 2019, 23 (4)