Prognostic Value of CONUT and ALBI in Metastatic Pancreatic Cancer: A Retrospective Cohort Study

Background: Metastatic pancreatic cancer carries a poor prognosis, and reliable prognostic markers are needed to guide treatment decisions. The Controlling Nutritional Status (CONUT) score and Albumin-Bilirubin (ALBI) grade are simple measures of inflammatory, nutritional, and hepatic status, but their prognostic value in metastatic pancreatic cancer remains unclear. This study aimed to evaluate the prognostic significance of CONUT and ALBI scores in patients with metastatic pancreatic cancer. Methods: This retrospective study included 192 patients with metastatic pancreatic cancer treated at Adana City Education and Research Hospital between 1 May 2019, and 1 February 2025. Baseline CONUT scores and ALBI grades were calculated. All laboratory parameters, including those used for CONUT and ALBI calculation, were obtained prior to the initiation of any systemic therapy. Overall survival (OS) was analyzed using Kaplan-Meier survival curves and multivariate Cox proportional hazards regression to assess the independent prognostic value of both indices. Results: The median OS of the cohort was 14.0 months. Patients with high CONUT scores had significantly shorter OS compared to those with low-moderate scores (7.8 vs. 14.0 months, p < 0.001). Similarly, ALBI Grade 2 was associated with worse survival than ALBI Grade 1 (13.0 vs. 14.0 months, p = 0.049). In multivariate Cox regression analysis, high CONUT score (HR = 5.01, 95% CI: 2.27-10.98, p < 0.001) and ALBI Grade 2 (HR = 17.86, 95% CI: 9.63-31.04, p < 0.001) remained independent predictors of poor OS. Conclusions: The CONUT and ALBI scores are independent and clinically meaningful prognostic markers in metastatic pancreatic cancer. Their routine use may support risk-adapted, personalized treatment. These readily accessible biomarkers offer a simple and accessible tool to guide clinical decisions.