Oops, you're using an old version of your browser so some of the features on this page may not be displaying properly.

MINIMAL Requirements: Google Chrome 24+Mozilla Firefox 20+Internet Explorer 11Opera 15–18Apple Safari 7SeaMonkey 2.15-2.23

Poster display session

167P - Prognostic impact of the C-reactive protein/albumin ratio in advanced pancreatic cancer treated with GEM plus nab-PTX or FOLFIRINOX: Based on the results of a multicenter retrospective study (the NAPOLEON study)


23 Nov 2019


Poster display session


Tumour Site

Pancreatic Adenocarcinoma


Akitaka Makiyama


Annals of Oncology (2019) 30 (suppl_9): ix42-ix67. 10.1093/annonc/mdz422


A. Makiyama1, J. Nakazawa2, T. Otsuka3, M. Shimokawa4, F. Koga5, Y. Ueda6, A. Komori7, S. Arima8, M. Fukahori9, T. Honda10, T. Shibuki11, T. Shirakawa12, K. Nio13, Y. Ide14, N. Ureshino3, K. Mitsugi15

Author affiliations

  • 1 Department Of Hematology/oncology, Japan Community Healthcare Organization Kyushu Hospital, 806-8501 - Kitakyushu/JP
  • 2 Department Of Gastroenterology And Hepatology, Kagoshima City Hospital, Kagoshima/JP
  • 3 Department Of Medical Oncology, Saga-ken Medical Centre Koseikan, Saga/JP
  • 4 Department Of Biostatistics, Yamaguchi University Graduate School of Medicine, 755-8505 - Ube/JP
  • 5 Department Of Hepato-biliary-pancreatic Medicine, Saga-ken Medical Centre Koseikan, Saga/JP
  • 6 Department Of Hematology And Oncology, Japanese Red Cross Kumamoto Hospital, Kumamoto/JP
  • 7 Department Of Medical Oncology And Hematology, Oita University Faculty of Medicine, Oita/JP
  • 8 Digestive And Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima/JP
  • 9 Department Of Medicine, Division Of Gastroenterology, Kurume University Hospital, Fukuoka/JP
  • 10 Department Of Gastroenterology And Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki/JP
  • 11 Department Of Gastroenterology, Imari Arita Kyoritsu Hospital, Saga/JP
  • 12 Department Of Medical Oncology, Fukuoka Wajiro Hospital, Fukuoka/JP
  • 13 Department Of Medical Oncology, Sasebo Kyosai Hospital, Nagasaki/JP
  • 14 Department Of Internal Medicine, Japanese Red Cross Karatsu Hospital, Saga/JP
  • 15 Department Of Medical Oncology, Hamanomachi Hospital, Fukuoka/JP


Login to get immediate access to this content.

If you do not have an ESMO account, please create one for free.

Abstract 167P


GEM plus nab-PTX (GnP) and FOLFIRINOX (FFX) have been shown to improve overall survival for advanced pancreatic cancer patients. However, clinical utility of C-reactive protein/albumin ratio (CAR) as prognostic factor for the patients treated with GnP or FFX remains unclear. We conducted the exploratory analysis to elucidate prognostic impact of CAR using a multicenter retrospective study (the NAPOLEON study) cohort which examined the efficacy and safety of GnP and FFX in clinical practice.


Between December 2013 to March 2017, 255 patients with unresectable advanced or recurrent pancreatic cancer who received GnP or FFX as 1st-line chemotherapy at 14 centers participating in the NAPOLEON study were examined. Patient characteristics at the start of 1st and 2nd line chemotherapy including age, gender, ECOG performance status, primary tumor site, disease status, metastatic site, underwent biliary drainage or not, treatment regimen at 1st line chemotherapy, LDH and CAR were analyzed to investigate correlation with prognosis by Cox regression model. The cut-off value of CAR adopted 0.54 based on a previous study. Patients were divided into groups according to CAR level less than 0.54 (CAR-low) and 0.54 or greater (CAR-high).


Cox regression analysis of OS identified underwent biliary drainage (HR: 1.76, 95%CI: 1.19–2.61), CAR-high (HR: 1.52, 95%CI: 1.05–2.21), and higher LDH level (HR: 2.10, 95%CI: 1.36–3.22) as significant factors at the start of 1st-line chemotherapy. Similarly, Cox regression analysis of OS identified a poor PS (HR: 1.62, 95%CI: 1.07–2.47), a high level of CA19-9 (HR: 2.14, 95%CI: 1.07–4.29) and CAR-high (HR: 2.15, 95%CI: 1.32–3.49) as significant factors at the start of 2nd-line chemotherapy. Eighty-six of 140 patients (82.7%) with CAR-high at the start of 1st-line chemotherapy still remained CAR-high at the start of 2nd-line chemotherapy.


CAR may be useful prognostic factor at the start of both 1st and 2nd-line treatment. Almost all the patients with CAR-high before 1st line treatment still remained CAR-high after 1st line treatment.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.


Has not received any funding.


All authors have declared no conflicts of interest.

This site uses cookies. Some of these cookies are essential, while others help us improve your experience by providing insights into how the site is being used.

For more detailed information on the cookies we use, please check our Privacy Policy.

Customise settings
  • Necessary cookies enable core functionality. The website cannot function properly without these cookies, and you can only disable them by changing your browser preferences.