Preoperative Glucose-to-Albumin Ratio as a Prognostic Marker for Survival in Pancreatic Cancer Patients Undergoing Pancreatectomy

Pancreatic cancer (PC) disrupts metabolic and nutritional processes, including glucose homeostasis and albumin levels. Both hyperglycemia and hypoalbuminemia have been linked to poorer outcomes in various cancers, including PC. This study investigates the preoperative glucose-to-albumin ratio (GAR) as a potential prognostic marker of overall survival in patients undergoing pancreatic resection for pancreatic ductal adenocarcinoma (PDAC).

This single-center retrospective analysis included patients who underwent curative-intent pancreatectomy for PDAC and adenosquamous carcinoma of the pancreas between 2017 and 2024. GAR was calculated from preoperative laboratory tests. Kaplan-Meier and Cox regression analyses were performed for recurrence-free and overall survival.

A total of 566 patients were included (51% males and 49% females, mean age 68.3); 548 had PDAC and 18 had adenosquamous carcinoma of the pancreas. High GAR was associated with elevated CA 19-9, CEA and BMI (p < 0.0001, p < 0.0001, p = 0.02, respectively), more advanced T staging (p = 0.001), increased tumor size (p = 0.007), and AJCC staging (p = 0.04), as well as perineural invasion (p = 0.01) and lymphovascular invasion (p = 0.008). Kaplan-Meier analysis demonstrated significantly worse overall survival in high GAR patients (26.6 vs. 35.0 months, p = 0.004), while low albumin was associated with significantly worse recurrence-free survival (15.5 vs. 20.7 months, p = 0.04). Cox regression identified high GAR (HR = 1.3, p = 0.04), lower BMI (Body Mass Index) (p = 0.02), higher CA 19-9 (p = 0.006), N staging (p = 0.002), histological tumor grading (p < 0.0001), neoadjuvant chemotherapy (p = 0.002) and perineural invasion (p = 0.03) as independent risk factors for poorer overall survival.

Higher preoperative GAR is associated with more advanced disease at presentation and an adverse prognosis in patients with resected PC.