ALB and metastasis: PDAC spreads widely to the various organs and tissues, especially the liver and peritoneum.20 Recent studies have suggested a prognostic index or model for OS based on hepatic or peritoneal metastasis, serum CRP, serum albumin, abdominal and/or back pain, or the performance status.8–10 Although these models could predict prognosis in patients with PDAC, all had potential limitations because of the complexity and subjectivity of some of the variables such as abdominal pain or performance status.