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PREOPERATIVE GLUCOSE-TO-ALBUMIN RATIO AS A PROGNOSTIC MARKER FOR SURVIVAL IN PANCREATIC CANCER PATIENTS UNDERGOING PANCREATECTOMY
Andrea Feci
*, Isabel Lavine, Sophia Shah, Matthew Kraft, Benjamin Varughese, Elijah Hoffman, Harish Lavu, Wilbur Bowne, Charles Yeo, Avinoam Nevler
Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA
Background: Pancreatic cancer is associated with significant perturbations in metabolic and nutritional markers, including glucose homeostasis and albumin levels. Both hyperglycemia and hypoalbuminemia have been linked to poorer outcomes in various cancers, including pancreatic cancer. This study investigates the preoperative glucose-to-albumin ratio (GAR) as a potential prognostic marker of overall survival in patients undergoing pancreatic resection for primary pancreatic ductal adenocarcinoma (PDAC).
Methods: A retrospective analysis was conducted on patients who underwent curative-intent pancreatectomy for resectable PDAC between 2017 and 2022 at a single institution. GAR was computed using preoperative blood glucose and serum albumin levels. Tumor histological grade, size and pathological staging, patient age, neoadjuvant and adjuvant chemotherapy, as well as preoperative CA 19-9 and CEA tumor markers, and established pathologic descriptors were considered as covariates and analyzed through bivariate correlations. Kaplan-Meier and Cox regression analyses were performed for recurrence-free and overall survivals.
Results: A total of 429 patients were included in the study, with 51% males and 49% females. The average age at surgery was 68.4 years (range 41.2 – 94.3 years). Among the patients, 417 were identified with PDAC and 12 with adenosquamous carcinoma of the pancreas. Elevated preoperative blood glucose levels were significantly correlated with larger tumor sizes (p=0.009), and higher tumor T staging (p=0.020). An inverse relationship was also found between serum albumin levels and both advanced nodal status (p=0.013) and presence of perineural invasion (p=0.038). Lymphovascular invasion (p=0.034) and preoperative CA 19-9 levels (p=0.021) were likewise inversely correlated with serum albumin. Survival analysis identified high GAR (above dataset median of 26.17 mg glucose/g albumin) as a prognostic factor of worse overall survival (35.2 vs 43.1 months, p=0.023). A Cox regression model identified lymphovascular invasion and age at surgery as significant risk factors; but not high GAR, nodal status, and perineural invasion.
Conclusions: Our analysis found that a higher preoperative GAR is associated with more aggressive disease characteristics in resectable PDAC, including higher tumor T stage, presence of perineural and lymphovascular invasion. Additionally, Kaplan-Meier survival analysis demonstrated that patients with high GAR experience significant worse survival after surgery. These findings highlight the potential role of GAR as an indicator of disease severity and value as a prognostic marker.
Figure: Kaplan-Meier Survival analysis of patients with resected pancreatic ductal adenocarcinoma shows worse overall survival in patients with high glucose-albumin ratio (GAR) compared with patients with low GAR (35.2 vs 43.1 months, p=0.023).
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