An elevated fibrinogen/CRP ratio predicts a remarkable survival advantage in patients with metastatic pancreatic cancer

Background

Both fibrinogen and C-reactive protein (CRP) are biomarkers of systemic inflammation, but differ regarding their half-life, underlying pathophysiological triggers, genetic background and cellular as well as molecular effects. The aim of this study was to investigate the fibrinogen/CRP ratio (FCR) as a prognostic blood-based biomarker for survival outcome in patients with pancreatic cancer.

Methods

609 consecutive patients with pancreatic adenocarcinoma (Stage I-III: n = 253 (41.5%), Stage IV: n = 356 (58.5%) from a tri-center cohort study (Austria and Switzerland) had routine measurements of fibrinogen and CRP levels at the time of diagnosis, and were followed until the occurrence of death-from-any-cause. The FCR was defined as the ratio of fibrinogen (in mg/dL) to CRP (in mg/L).

Results

During a median follow-up period of 3.8 years (range: 3 days-8.4 years), 511 (83.9%) patients died (1-, 3-, and 5-year overall survival (OS) probabilities (95%CI): 45.2% (41.1-49.2), 14.0% (11.2-17.2), and 7.4% (5.0-10.4), respectively. Patients with an elevated FCR, defined as an FCR > 75^th percentile of the FCR distribution (cut-off: 145.3 units), had a significantly higher 1-year OS than patients ≤ this cut-off (60.2% vs. 40.2%, p 

Conclusions

In this large tri-center cohort of patients with pancreatic adenocarcinoma, we observed a strong association between a high FCR and a lower risk of death in patients with metastatic disease but not in patients with localized disease. An elevated FCR at baseline defines a novel clinical subset of patients with metastatic pancreatic cancer who have a remarkable survival advantage.

Clinical trial identification

Legal entity responsible for the study

N/A

Funding

University Graz, Salzburg, Zurich

Disclosure

All authors have declared no conflicts of interest.