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C-Reactive Protein-to-Albumin Ratio as a Predictive Indicator for Evaluating Tolerability in S-1 Adjuvant Chemotherapy after Curative Surgery for Pancreatic Cancer: An External Validation Cohort Study
by
, , and
Naotake Funamizu
1,*
,
Shozo Mori
2,
Akimasa Sakamoto
1,
Miku Iwata
1,
Mikiya Shine
1,
Chihiro Ito
1,
Mio Uraoka
1,
Yoshitomo Ueno
1,
Kei Tamura
1,
Yuzo Umeda
1,
Taku Aoki
2 and
Yasutsugu Takada
1 1
Department of Hepato-Biliary Pancreatic and Transplantation Surgery, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon 791-0295, Ehime, Japan
2
Department of Hepato-Biliary Pancreatic Surgery, Dokkyo Medical University, Kitakobayashi 880, Mibu, Shimotsugagun 321-0293, Tochigi, Japan
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(19), 3372; https://doi.org/10.3390/cancers16193372 (registering DOI)
Submission received: 2 September 2024
/
Revised: 26 September 2024
/
Accepted: 30 September 2024
/
Published: 1 October 2024
(This article belongs to the Special Issue Oncology: State-of-the-Art Research and Initiatives in Japan)
Simple Summary
Adjuvant chemotherapy (AC) using S-1 has demonstrated favorable outcomes for patients with pancreatic cancer (PC). However, the current S-1 completion rate is insufficient to achieve its benefits. Moreover, an absence of dependable markers to forecast S-1 completion warrants C-reactive protein-to-albumin ratio (CAR) investigation as a potential predictive factor related to nutritional status. Previously, we revealed that a postoperative CAR value of ≥0.05 serves as a marker predicting S-1 AC treatment non-completion due to adverse events (AEs) in the Ehime study. Thus, this study aims to substantiate the correlation between postoperative CAR and S-1 therapy non-completion due to AEs using an alternative cohort from another institution (the Dokkyo study).
Abstract
Background: S-1 in adjuvant chemotherapy (AC) administration after pancreatic cancer (PC) surgery has been standardized in Japan. The Ehime study confirmed that a postoperative higher C-reactive protein-to-albumin ratio (CAR) value predicted the risk of adverse event (AE)-related S-1 non-completion as an AC in patients with PC after curative surgery. This study aimed to investigate the index to predict S-1 tolerance among patients who underwent curative surgery for PC (the Dokkyo study). Methods: This retrospective validation cohort study included 172 patients at the Department of Hepato-Biliary Pancreatic Surgery, Dokkyo Medical University, Japan, from January 2010 to December 2022. All patients underwent nutritional screening using the postoperative CAR. S-1 completion status and its effect on prognosis were systematically followed up and investigated. We conducted a statistical analysis of predictive markers to investigate their association with S-1 completion. Results: Patients were categorized into the S-1 completion (N = 91) and non-completion (N = 81) groups. The S-1 completion group demonstrated a significantly lower CAR than the S1 non-completion group. Moreover, the current study revealed a significant difference in the S-1 completion rate, applying the CAR cutoff value of 0.05 established in the Ehime study. Additionally, univariate and multivariate analyses confirmed that a CAR of <0.05 was significantly associated with S-1 completion. Conclusions: The Dokkyo study confirmed the results observed in the Ehime study. Consequently, an increased postoperative CAR value appeared as a universal applicable marker for the risk factor of AE-related S-1 non-completion after curative surgery for patients with PC.
