ArticleOncology letters2026
Investigation of CRP and NLR as potential biomarkers for redefining biological borderline resectable pancreatic cancer.
Article in Oncology letters, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Anatomically resectable pancreatic cancer with markedly elevated carbohydrate antigen 19-9 (CA19-9) levels has recently been recognized as a biologically borderline resectable (BR-B) disease due its poor prognosis. The present study evaluated whether C-reactive protein (CRP) levels and the neutrophil-to-lymphocyte ratio (NLR) could further refine preoperative prognostic stratification. Data from 154 patients with resectable (R) and BR-B pancreatic cancer who underwent resection with curative intent between March 2014 and June 2024 were retrospectively analyzed. Based on the 2017 International Consensus Criteria, BR-B was defined as resectable pancreatic cancer with a serum CA19-9 level >500 U/ml. Prognostic factors were assessed using Cox proportional hazards regression analysis. Among the 154 patients, 128 were classified as R and 26 as BR-B. Multivariate analysis identified a CA19-9 level ≥500 U/ml (P<0.001), CRP level ≥0.3 mg/dl (P=0.003) and NLR ≥3.13 (P=0.008) as independent predictors of poor overall survival. Survival progressively worsened with an increasing number of elevated biomarkers. Patients with no elevated biomarker levels experienced the most favorable outcomes. The CRP level and NLR were independent prognostic biomarkers for pancreatic cancer. However, their integration with CA19-9 levels enables more refined preoperative prognostic stratification and may help guide individualized treatment strategies, including the selection of patients for neoadjuvant chemotherapy or upfront surgery.
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