Advances in medical sciences · 2026
Can liver-associated parameters serve as prognostic factors in pancreatic cancer? - A retrospective analysis of a large-capacity centre.
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Fudalej Marta, Badowska-Kozakiewicz Anna, Deptała Andrzej
Аннотация
PURPOSE: The study aimed to analyze pretreatment liver parameters among patients with pancreatic cancer (PC) and determine their prognostic value.
MATERIALS/METHODS: A total of 310 patients with a confirmed PC diagnosis were screened for available liver parameters in routine blood sample analysis before the first round of chemotherapy. The assessed parameters included alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, alkaline phosphatase (ALP), and albumin. Two indices were calculated: AST/ALT and albumin/ALP ratios. Statistical analyses were performed utilizing appropriate tests.
RESULTS: An elevated AST/ALT ratio was associated with more than a twofold increase in mortality risk (HR = 2.13, 95% CI 1.40-3.24, p < 0.001); however, this association did not remain statistically significant after adjustment for age and disease stage in the multivariate analysis. The calculated AST/ALT ratio cut-off did not effectively distinguish between patients with different tumor characteristics. Therefore, stratification based on this ratio may not be informative in PC. Pretreatment albumin and total bilirubin levels significantly predicted mortality (albumin value > 4.31 g/dL: HR = 0.49, 95% CI 0.30-0.80, p = 0.004, and total bilirubin >0.77 mg/dL: HR = 2.30, 95% CI 1.67-3.17, p < 0.001) and helped classify patients. Neither ALP alone nor the albumin/ALP ratio appeared to serve as a valuable prognostic factor.
CONCLUSIONS: Our study further confirmed that liver function can influence the prognosis of patients with PC. The exact values of liver parameters in clinical practice should be established through a large, prospective, multicenter study.
MATERIALS/METHODS: A total of 310 patients with a confirmed PC diagnosis were screened for available liver parameters in routine blood sample analysis before the first round of chemotherapy. The assessed parameters included alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, alkaline phosphatase (ALP), and albumin. Two indices were calculated: AST/ALT and albumin/ALP ratios. Statistical analyses were performed utilizing appropriate tests.
RESULTS: An elevated AST/ALT ratio was associated with more than a twofold increase in mortality risk (HR = 2.13, 95% CI 1.40-3.24, p < 0.001); however, this association did not remain statistically significant after adjustment for age and disease stage in the multivariate analysis. The calculated AST/ALT ratio cut-off did not effectively distinguish between patients with different tumor characteristics. Therefore, stratification based on this ratio may not be informative in PC. Pretreatment albumin and total bilirubin levels significantly predicted mortality (albumin value > 4.31 g/dL: HR = 0.49, 95% CI 0.30-0.80, p = 0.004, and total bilirubin >0.77 mg/dL: HR = 2.30, 95% CI 1.67-3.17, p < 0.001) and helped classify patients. Neither ALP alone nor the albumin/ALP ratio appeared to serve as a valuable prognostic factor.
CONCLUSIONS: Our study further confirmed that liver function can influence the prognosis of patients with PC. The exact values of liver parameters in clinical practice should be established through a large, prospective, multicenter study.