Gamma-Glutamyl Transferase/Albumin Ratio and Alkaline Phosphatase/Albumin Ratio as Novel Prognostic Markers for Metastatic Pancreatic Cancer

ABS TRACT Objective: Metastatic pancreatic cancer is a common condition and highly lethal condition, emphasizing the urgent need for novel prognostic markers. This study investigated the effect of the gamma-glutamyl transferase/albumin ratio (GAR) and alkaline phosphatase/albumin ratio (APAR) on prognosis. Material and Methods: We conducted a retrospective examination 287 patients diagnosed with metastatic pancreatic cancer between January 2008 2019. Results: The median age was 65 years, and obstructive jaundice was present in 58 (20.2%). Median overall-surviva (OS) was significantly longer in patients without jaundice (6.0 vs. 3.0 months, p=0.005). Furthermore, median OS and progression-free survival (PFS) were extended in the low-GAR-group (6.0 vs. 4.0 months, p=0.001; 5.0 vs. 3.0 months, p<0.01, respectively). Similarly, patients in the low APAR group exhibited longer median OS and PFS (6.0 vs. 3.0 months, p<0.01; 5.0 vs. 3.0 months, p<0.01, respectively). The low neutrophil-to-lymphocyte-ratio (NLR) group demonstrated prolonged median OS and PFS (8.0 vs. 3.0 months, p<0.01; 6.0 vs. 3.0 months, p<0.01, respectively). Additionally, patients in the high prognostic-nutritional-index (PNI) group experienced extended median OS and PFS (6.0 vs. 3.0 months, p<0.01; 5.0 vs. 2.0 months, p=0.02, respectively). Furthermore, members of the low-GAR-group were significantly more prevalent in the low-NLR and low platelet-to-lymphocyte-ratio-groups (79.4% vs. 20.6%, p=0.02 and 75.9% vs. 24.1%, p=0.04, respectively). By contrast, the low-APAR-group had significantly more members than the high-PNI-group (90% vs. 10%, p<0.01). Conclusion: In metastatic pancreatic cancer, both OS and PFS significantly extend in the low-GAR, APAR, and NLR groups, while the high-PNI-group also exhibits enhanced OS and PFS. These findings must be supported by further studies .