In 557 neuroendocrine tumor patients receiving peptide receptor radionuclide therapy (PRRT), low albumin and elevated CRP predicted worse overall survival, while derived neutrophil-to-lymphocyte ratio did not improve prognostic accuracy.
HR 3.60 for GPS 2 vs 0Patients with both low albumin and high CRP (GPS score 2) had 3.6x higher mortality risk during PRRT than those with normal values
What the researchers found
Hypoalbuminemia (HR 0.91 per unit) and elevated CRP (HR 1.02 per unit) independently predicted shorter overall survival in PRRT-treated NET patients. GPS score of 2 vs. 0 had HR 3.60. Albumin was the single most valuable addition to established prognostic models, while dNLR added no value.
Why it matters
PRRT is a major peptide-based cancer therapy for neuroendocrine tumors. Identifying which patients benefit most through simple blood tests like albumin and CRP could help clinicians personalize treatment decisions and avoid exposing unlikely responders to radiation.
The numbers in context
557 patients, treated 2005-2015. Albumin HR: 0.91 per unit (95% CI: 0.87-0.95). GPS 2 vs 0 HR: 3.60 (95% CI: 2.24-5.79). CRP/albumin ratio HR: 1.84 (95% CI: 1.43-2.37). dNLR was not significant.
How the study worked
Retrospective cohort study of 557 NET patients treated with PRRT at a tertiary referral center (2005-2015), using Cox proportional hazard models and Akaike information criterion for model comparison.
Who was studied
Neuroendocrine tumor patients undergoing PRRT at a tertiary referral center
What this study cannot tell us
Retrospective single-center design limits generalizability. Blood markers were measured at variable time points relative to PRRT. ESR analysis was exploratory in a subset only. The study did not assess whether modifying inflammation markers could improve outcomes.
How to read the evidence
Large retrospective cohort study (n=557) with appropriate statistical methodology. Robust finding for albumin/CRP but limited by retrospective design and single-center data.
When this study was published
Published in 2025 using data from 2005-2015; findings are applicable to current PRRT clinical practice.
The bigger picture
This study reinforces that the inflammatory state of cancer patients—measurable through simple, inexpensive blood tests—significantly affects outcomes of peptide-based cancer therapies. Incorporating albumin and CRP into PRRT treatment planning could improve patient selection and outcome prediction.
Questions still open
- Could improving albumin levels before PRRT enhance treatment outcomes?
- Should hypoalbuminemia be a factor in deciding whether to offer PRRT to NET patients?
- Would ESR outperform albumin as a prognostic marker in a prospective validation study?
Common questions
What is peptide receptor radionuclide therapy (PRRT)?
Why does low albumin predict worse outcomes with PRRT?
Read the original research
Hypoalbuminemia, but not derived neutrophil to lymphocyte ratio (dNLR), predicts overall survival in neuroendocrine tumours undergoing peptide receptor radionuclide therapy: A retrospective, cohort study of 557 patients.
Journal of neuroendocrinology, 37(3), e13379
Citation
Papantoniou, Dimitrios; Fröss-Baron, Katarzyna; Garske-Román, Ulrike; Sundin, Anders; Thiis-Evensen, Espen; Grönberg, Malin; Welin, Staffan; Tiensuu Janson, Eva. (2025). Hypoalbuminemia, but not derived neutrophil to lymphocyte ratio (dNLR), predicts overall survival in neuroendocrine tumours undergoing peptide receptor radionuclide therapy: A retrospective, cohort study of 557 patients.. Journal of neuroendocrinology, 37(3), e13379. https://doi.org/10.1111/jne.13379