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Takemoto Y, Tanabe K, Chikuie E, Saeki Y, Ota H, Karakuchi N, Kohata A, Ohdan H. Preoperative High C-Reactive Protein to Albumin Ratio Predicts Short- and Long-Term Postoperative Outcomes in Elderly Gastric Cancer Patients. Cancers (Basel) 2024; 16:616. [PMID: 38339365 PMCID: PMC10854578 DOI: 10.3390/cancers16030616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/12/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Individualized preoperative assessment of the general condition of elderly patients with gastric cancer is necessary for appropriate surgical treatment planning. This study investigated the efficacy of preoperative markers that could be easily calculated from preoperative peripheral blood to predict the short- and long-term postoperative outcomes of gastrectomy. In total, 571 patients who underwent R0 surgical resection for gastric cancer were enrolled. In the elderly patient group (≥65 years old), univariate analyses revealed that the incidence of postoperative complications was associated with poor performance status (p = 0.012), more comorbidities (p = 0.020), high C-reactive protein to albumin ratio (CAR, p = 0.003), total gastrectomy (p = 0.003), open approach (p = 0.034), blood transfusion (p = 0.002), and advanced cancer (p = 0.003). Multivariate analysis showed that a high CAR was associated with a high incidence of postoperative complications (p = 0.046). High CAR was also associated with poor OS (p = 0.015) and RFS (p = 0.035). However, these trends were not observed among younger patients (<65 years old). Preoperative CAR may play a significant role in predicting short- and long-term surgical outcomes, particularly in elderly patients with gastric cancer.
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Affiliation(s)
- Yuki Takemoto
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.T.)
| | - Kazuaki Tanabe
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Emi Chikuie
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.T.)
| | - Yoshihiro Saeki
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.T.)
| | - Hiroshi Ota
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.T.)
| | - Nozomi Karakuchi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.T.)
| | - Akihiro Kohata
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.T.)
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.T.)
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Yamashita M, Tominaga T, Nonaka T, Hisanaga M, Takeshita H, Fukuoka H, To K, Tanaka K, Sawai T, Nagayasu T. Short-term outcomes after laparoscopic colorectal cancer surgery in patients over 90 years old: a Japanese multicenter study. BMC Surg 2024; 24:2. [PMID: 38166905 PMCID: PMC10763673 DOI: 10.1186/s12893-023-02298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The effect of laparoscopic surgery on short-term outcomes in colorectal cancer patients over 90 years old has remained unclear. METHODS We reviewed 87 colorectal cancer patients aged over 90 years who underwent surgery between 2016 and 2022. Patients were divided into an open surgery group (n = 22) and a laparoscopic surgery group (n = 65). The aim of this study was to investigate the effect of laparoscopic surgery on postoperative outcome in elderly colorectal cancer patients, as compared to open surgery. RESULTS Seventy-eight patients (89.7%) had comorbidities. Frequency of advanced T stage was lower with laparoscopic surgery (p = 0.021). Operation time was longer (open surgery 146 min vs. laparoscopic surgery 203 min; p = 0.002) and blood loss was less (105 mL vs. 20 mL, respectively; p < 0.001) with laparoscopic surgery. Length of hospitalization was longer with open surgery (22 days vs. 18 days, respectively; p = 0.007). Frequency of infectious complications was lower with laparoscopic surgery (18.5%) than with open surgery (45.5%; p = 0.021). Multivariate analysis revealed open surgery (p = 0.026; odds ratio, 3.535; 95% confidence interval, 1.159-10.781) as an independent predictor of postoperative infectious complications. CONCLUSIONS Laparoscopic colorectal resection for patients over 90 years old is a useful procedure that reduces postoperative infectious complications.
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Affiliation(s)
- Mariko Yamashita
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Makoto Hisanaga
- Department of Surgery, Sasebo City General Hospital, Nagasaki, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | | | - Kazuo To
- Department of Surgery, Ureshino Medical Center, Ureshino, Japan
| | - Kenji Tanaka
- Department of Surgery, Saiseikai Nagasaki Hospital, Nagasaki, Japan
| | - Terumitsu Sawai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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van Holstein Y, van den Berkmortel PJE, Trompet S, van Heemst D, van den Bos F, Roemeling-van Rhijn M, de Glas NA, Beekman M, Slagboom PE, Portielje JEA, Mooijaart SP, van Munster BC. The association of blood biomarkers with treatment response and adverse health outcomes in older patients with solid tumors: A systematic review. J Geriatr Oncol 2023; 14:101567. [PMID: 37453811 DOI: 10.1016/j.jgo.2023.101567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 06/01/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Blood biomarkers are potentially useful prognostic markers and may support treatment decisions, but it is unknown if and which biomarkers are most useful in older patients with solid tumors. The aim of this systematic review was to evaluate the evidence on the association of blood biomarkers with treatment response and adverse health outcomes in older patients with solid tumors. MATERIALS AND METHODS A literature search was conducted in five databases in December 2022 to identify studies on blood biomarkers measured before treatment initiation, not tumor specific, and outcomes in patients with solid tumors aged ≥60 years. Studies on any type or line of oncologic treatment could be included. Titles and abstracts were screened by three authors. Data extraction and quality assessment, using the Quality in Prognosis Studies (QUIPS) checklist, were performed by two authors. RESULTS Sixty-three studies were included, with a median sample size of 138 patients (Interquartile range [IQR] 99-244) aged 76 years (IQR 72-78). Most studies were retrospective cohort studies (63%). The risk of bias was moderate in 52% and high in 43%. Less than one-third reported geriatric parameters. Eighty-six percent examined mortality outcomes, 37% therapeutic response, and 37% adverse events. In total, 77 unique markers were studied in patients with a large variety of tumor types and treatment modalities. Neutrophil-to-lymphocyte ratio (20 studies), albumin (19), C-reactive protein (16), hemoglobin (14) and (modified) Glasgow Prognostic Score ((m)GPS) (12) were studied most often. The vast majority showed no significant association of these biomarkers with outcomes, except for associations between low albumin and adverse events and high (m)GPS with mortality. DISCUSSION Most studies did not find a significant association between blood biomarkers and clinical outcomes. The interpretation of current evidence on prognostic blood biomarkers is hampered by small sample sizes and inconsistent results across heterogeneous studies. The choice for blood biomarkers in the majority of included studies seemed driven by availability in clinical practice in retrospective cohort studies. Ageing biomarkers are rarely studied in older patients with solid tumors. Further research is needed in larger and more homogenous cohorts that combine clinical parameters and biomarkers before these can be used in clinical practice.
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Affiliation(s)
- Yara van Holstein
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands.
| | - P Janne E van den Berkmortel
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands
| | - Stella Trompet
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands
| | - Diana van Heemst
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands
| | - Frederiek van den Bos
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands
| | | | - Nienke A de Glas
- Department of Medical Oncology, Leiden University Medical Center, the Netherlands
| | - Marian Beekman
- Department of Biomedical Data Sciences, section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands
| | - P Eline Slagboom
- Department of Biomedical Data Sciences, section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands
| | | | - Simon P Mooijaart
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands
| | - Barbara C van Munster
- Department of Internal Medicine, University Medical Center Groningen, the Netherlands
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Sahakyan MA, Kleive D, Dille-Amdam RG, Kjeseth T, Waardal K, Edwin B, Nymo LS, Lassen K. The Role of Preoperative Inflammatory Markers in Pancreatectomy: a Norwegian Nationwide Cohort Study. J Gastrointest Surg 2023; 27:1650-1659. [PMID: 37322265 PMCID: PMC10412490 DOI: 10.1007/s11605-023-05726-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/27/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND PURPOSE Preoperative inflammatory markers, such as Glasgow prognostic score, modified Glasgow prognostic score and C-reactive protein to albumin ratio, were shown to be associated with prognosis in patients undergoing pancreatectomy for cancer. However, little is known about their predictive role in a Western population. METHODS The Norwegian National Registry for Gastrointestinal Surgery (NORGAST) was used to capture all pancreatectomies performed within the study period (November 2015-April 2021). The association between the preoperative inflammatory markers and postoperative outcomes was studied. Their impact on survival was examined in patients operated for pancreatic ductal adenocarcinoma. RESULTS A total of 1554 patients underwent pancreatectomy in this period. Glasgow prognostic score, modified Glasgow prognostic score and C-reactive protein to albumin ratio were associated with severe complications (Accordion grade ≥ III) in the univariable but not in the multivariable analysis. C-reactive protein to albumin ratio, but not Glasgow prognostic score and modified Glasgow prognostic score, was linked to survival following pancreatectomy for ductal adenocarcinoma. In the multivariable model, age, neoadjuvant chemotherapy, ECOG score, C-reactive protein to albumin ratio and total pancreatectomy correlated with survival. Also, preoperative C-reactive protein to albumin ratio was significantly associated with survival after pancreatoduodenectomy. CONCLUSIONS Preoperative Glasgow prognostic score, modified Glasgow prognostic score and C-reactive protein to albumin ratio have no role in predicting the complications after pancreatectomy. C-reactive protein to albumin ratio is a significant predictor for survival in ductal adenocarcinoma, yet its clinical relevance should be explored in conjunction with the pathology parameters and adjuvant therapy.
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Affiliation(s)
- Mushegh A Sahakyan
- The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
- Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
- Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia.
| | - Dyre Kleive
- Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Rachel G Dille-Amdam
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Trond Kjeseth
- Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Kim Waardal
- Department of Acute and Digestive Surgery, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Edwin
- The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Linn S Nymo
- Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway
- Institute of Clinical Medicine, UiT, the Arctic University of Norway, Tromsø, Norway
| | - Kristoffer Lassen
- Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, UiT, the Arctic University of Norway, Tromsø, Norway
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Predictive value of the Naples prognostic score on postoperative outcomes in patients with rectal cancer. Langenbecks Arch Surg 2023; 408:113. [PMID: 36859650 DOI: 10.1007/s00423-023-02851-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/21/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE The Naples prognostic score (NPS) is a prognostic index based on the nutritional and inflammatory status. However, its utility in predicting postoperative complications (POCs) has not been examined in rectal cancer (RC). We evaluated the predictive value of the preoperative NPS for POCs in RC. METHODS We retrospectively analyzed 235 patients who underwent surgery for RC. The NPS was calculated based on serum albumin, serum total cholesterol, the neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte-to-monocyte ratio (LMR). Severe POCs were defined as Clavien-Dindo classification grade ≥ III. The optimal cut-off value of the NPS was determined by a receiver operator characteristic (ROC) curve analysis. The NPS, NLR, LMR, platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP)-to-albumin ratio (CAR), Glasgow prognostic score (GPS), Onodera prognostic nutritional index (PNI) and controlling nutritional status score (CONUT) were investigated as inflammation-based and/or nutritional markers. Predictors of severe POCs were analyzed by logistic regression modeling. RESULTS Severe POCs were observed in 64 patients (27.2%). Male sex, operation time (> 257 min), blood loss (≥ 30 mL), albumin (< 4.0 g/dL), CRP (≥ 1.0 mg/dL), total cholesterol (≤ 180 mg/dL), NPS (≥ 2), LMR (≥ 3.48), PLR (≥ 103.6), CAR (> 0.025), GPS (≥ 1), PNI (< 48.1) and CONUT (≥ 2) were significantly associated with severe POCs. The multivariate analysis revealed that male sex, operation time (> 257 min), and a high NPS (≥ 2) were independent predictors of severe POCs. The ROC curve analysis revealed that the NPS had the greatest predictive value among the inflammation-based and/or nutritional markers. CONCLUSION The NPS is a valuable predictor of severe POCs in RC.
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Tominaga T, Nonaka T, Oyama S, Takamura Y, Hashimoto S, Shiraishi T, Sawai T, Nagayasu T. Efficacy of Neutrophil-to-Lymphocyte Ratio for Cancer-Specific Survival in Elderly Patients with Localized Colon Cancer: A Single Center Propensity Score-Matched Analysis. Clin Exp Gastroenterol 2023; 16:1-9. [PMID: 36636228 PMCID: PMC9830562 DOI: 10.2147/ceg.s385207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/22/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose The prognostic value of neutrophil-to-lymphocyte ratio (NLR) has been studied for colorectal cancer. Elderly patients in general tend to have comorbidities and decreased organ function that potentially influence the NLR score. The aim of this study was to investigate the relationship between NLR and cancer-specific survival in elderly patients with colon cancer, using a propensity score-matched analysis. Patients and Methods A total of 203 patients aged over 75 years who underwent curative resection for colon cancer and were diagnosed pathologically with stage II/III disease were eligible for entry to the study. Patients were divided into two groups according to NLR score: NLR-High (NLR≥4.5) group (NLR-H, n=60) and NLR-Low (NLR<4.5) group (NLR-L, n=143). After propensity score matching, 57 patients in each group were matched. Results Before matching, Charlson comorbidity index was significantly higher in the NLR-H group (4 vs 2, p<0.001). After matching, all factors were similar between the groups. The median follow-up period was 43 months (range, 1-160 months). Five-year relapse-free-survival (69.8% vs 87.3%, p=0.030) and cancer-specific survival (83.0% vs 96.0%, p=0.042) were significantly lower in the NLR-H group. Conclusion NLR appears to be a cancer-specific prognostic marker in elderly patients with colon cancer.
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Affiliation(s)
- Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan,Correspondence: Tetsuro Tominaga, Department of Surgical Oncology, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan, Tel +81-95-819-7304, Fax +81-95-819-7306, Email
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Shosaburo Oyama
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Yuma Takamura
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Shintaro Hashimoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Toshio Shiraishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Terumitsu Sawai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
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Xie W, Huang X, Wei C, Mo X, Ru H, Zhang L, Ge L, Tang W, Liu J. Preoperative Neutrophil-BMI Ratio As a Promising New Marker for Predicting Tumor Outcomes in Colorectal Cancer. Technol Cancer Res Treat 2022; 21:15330338211064077. [PMID: 35225701 PMCID: PMC8891895 DOI: 10.1177/15330338211064077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Inflammation and nutritional status are highly associated with colorectal cancer (CRC) prognosis. This study aimed to evaluate the prognostic value of the preoperative neutrophil-BMI ratio (NBR) in patients with CRC. Methods: A retrospective analysis was performed on 2471 patients with CRC who underwent surgical resection between 2004 and 2019. Patients were divided into two groups based on the cutoff value for NBR. Cox regression and Kaplan–Meier curves were used to evaluate overall survival (OS). Results: High NBR was associated with female sex, low BMI, colon, right-sided CRC, poor differentiation, T3 to 4 stage, M1 to 2 stage, high carcinoembryonic antigen (CEA) level, III-IV stage, microsatellite instability (MSI), and no adjuvant chemotherapy (all P < .05). The high NBR group had a shorter OS than the low NBR group. Female and right sided patients with CRC and with high NBR had a worse prognosis. Univariate Cox regression suggested that NBR was significantly associated with poor prognosis. Multivariate analysis confirmed that age (P = .019,HR:1.012), differentiation (P = .001,HR:1.306), TNM stage (P < .001,HR:2.432), CEA (P = .014,HR:1.001), and NBR (P < .001, HR: 3.309) were independent poor prognostic factors for OS. Subgroup univariate analysis indicated that female patients with high NBR had a worse prognosis. A nomogram composed of TNM stage, CEA, and NBR was developed, and internal validation was based on female patients with CRC. The nomogram provided good discrimination for both the training and validation sets, with area under the curve values of 0.79 and 0.769, respectively. Conclusions: High preoperative levels of NBR are indicators of poor prognosis in patients with CRC.
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Affiliation(s)
- Weishun Xie
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Department of Endoscopy, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Xiaoliang Huang
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Chunyin Wei
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Xianwei Mo
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Haiming Ru
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Lihua Zhang
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Lianying Ge
- Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Department of Endoscopy, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Weizhong Tang
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
| | - Jungang Liu
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China.,Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China
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Hosaka H, Takeuchi M, Imoto T, Yagishita H, Yu A, Maeda Y, Kobayashi Y, Kadota Y, Odaira M, Toriumi F, Endo T, Harada H. Machine Learning-based Model for Predicting Postoperative Complications among Patients with Colonic Perforation: A Retrospective study. JOURNAL OF THE ANUS RECTUM AND COLON 2021; 5:274-280. [PMID: 34395940 PMCID: PMC8321583 DOI: 10.23922/jarc.2021-010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/29/2021] [Indexed: 11/30/2022]
Abstract
Objectives: Surgery for colonic perforation has high morbidity and mortality rates. Predicting complications preoperatively would help improve short-term outcomes; however, no predictive risk stratification model exists to date. Therefore, the current study aimed to determine risk factors for complications after colonic perforation surgery and use machine learning to construct a predictive model. Methods: This retrospective study included 51 patients who underwent emergency surgery for colorectal perforation. We investigated the connection between overall complications and several preoperative indicators, such as lactate and the Glasgow Prognostic Score. Moreover, we used the classification and regression tree (CART), a machine-learning method, to establish an optimal prediction model for complications. Results: Overall complications occurred in 32 patients (62.7%). Multivariate logistic regression analysis identified high lactate levels [odds ratio (OR), 1.86; 95% confidence interval (CI), 1.07-3.22; p = 0.027] and hypoalbuminemia (OR, 2.56; 95% CI, 1.06-6.25; p = 0.036) as predictors of overall complications. According to the CART analysis, the albumin level was the most important parameter, followed by the lactate level. This prediction model had an area under the curve (AUC) of 0.830. Conclusions: Our results determined that both preoperative albumin and lactate levels were valuable predictors of postoperative complications among patients who underwent colonic perforation surgery. The CART analysis determined optimal cutoff levels with high AUC values to predict complications, making both indicators clinically easier to use for decision making.
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Affiliation(s)
- Hiroka Hosaka
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan.,Department of Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Masashi Takeuchi
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan.,Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomohiro Imoto
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Haruka Yagishita
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Ayaka Yu
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Yusuke Maeda
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Yosuke Kobayashi
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Yoshie Kadota
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Masanori Odaira
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Fumiki Toriumi
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Takashi Endo
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Hirohisa Harada
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
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9
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Liu X, Guo X, Zhang Z. Preoperative Serum Hypersensitive-c-Reactive-Protein (Hs-CRP) to Albumin Ratio Predicts Survival in Patients with Luminal B Subtype Breast Cancer. Onco Targets Ther 2021; 14:4137-4148. [PMID: 34276217 PMCID: PMC8277447 DOI: 10.2147/ott.s320111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/15/2021] [Indexed: 12/18/2022] Open
Abstract
Objective To evaluate the clinical prognostic significance of preoperative serum hypersensitive-c-reactive-protein (Hs-CRP) to albumin ratio (CAR) in patients with luminal B subtype breast cancer. Methods A total of 199 patients with luminal B subtype breast cancer enrolled in this study were analyzed retrospectively. The optimal cutoff value of CAR was performed by the receiver operating characteristic curve (ROC). The associations between luminal B subtype breast cancer and clinicopathological variables by CAR were performed by chi-square test. Kaplan–Meier and log rank method were used for survival analysis. The independent prognostic factors were determined by univariate and multivariate Cox’s proportional hazards regression model. Results The patients were divided into low CAR group (CAR<0.044) and high CAR group (CAR≥0.044) by ROC. CAR was the independent factor by univariate and multivariate analysis, and the mean DFS and OS in the low CAR group survived longer than those in the high CAR group (p<0.05). According to the endocrine therapy with aromatase inhibitors, the mean survival time of DFS and OS in the low CAR group was significantly higher than that in the high CAR group (p<0.05). Moreover, patients with pathological I+II stage survived longer than those with pathological III stage, and the mean survival time of DFS and OS in the low CAR group was significantly higher than that in the high CAR group (p<0.05). Patients without lymph vessel invasion survived longer than those with lymph vessel invasion (p<0.05), and the mean survival time of DFS and OS in low the CAR group was significantly higher than that in the high CAR group (p<0.05). Conclusion Preoperative CAR was significantly associated with survival and prognosis of breast cancer, and it can be used as a routine prognostic indicator to predict the prognosis of luminal B subtype breast cancer.
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Affiliation(s)
- Xiujun Liu
- Department of Thyroid and Breast Surgery, Bayan Nur Hospital, Bayannaoer, 015000, Neimenggu, People's Republic of China
| | - Xiuchun Guo
- Deparment of Internal Medicine-Oncology, Bayan Nur Hospital, Bayannaoer, 015000, Neimenggu, People's Republic of China
| | - Zhiqiang Zhang
- Department of Thyroid and Breast Surgery, Bayan Nur Hospital, Bayannaoer, 015000, Neimenggu, People's Republic of China
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Liao CK, Yu YL, Lin YC, Hsu YJ, Chern YJ, Chiang JM, You JF. Prognostic value of the C-reactive protein to albumin ratio in colorectal cancer: an updated systematic review and meta-analysis. World J Surg Oncol 2021; 19:139. [PMID: 33933070 PMCID: PMC8088626 DOI: 10.1186/s12957-021-02253-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022] Open
Abstract
Backgrounds The inflammatory biomarker “C-reactive protein to albumin ratio (CAR)” has been reported to significantly correlate to a variety of human cancers. However, there are conflicting results regarding the prognostic value of CAR in colorectal cancer. Previous studies mainly assessed patients in Eastern countries, so their findings may not be applicable to the Western population. Therefore, this updated meta-analysis aimed to investigate the prognostic value of pre-treatment CAR and outcomes of patients with colorectal cancer. Methods We conducted a systematic search for eligible literature until October 31, 2020, using PubMed and Embase databases. Studies assessing pre-treatment CAR and outcomes of colorectal cancer were included. Outcome measures included overall survival, disease-free survival, progression-free survival, and clinicopathological features. The pooled hazard ratios (HR) with 95% confidence intervals (CI) were used as effective values. Results A total of 15 studies involving 6329 patients were included in this study. The pooled results indicated that a high pre-treatment CAR was associated with poor overall survival (HR 2.028, 95% CI 1.808−2.275, p < 0.001) and poor disease-free survival/progression-free survival (HR 1.768, 95% CI 1.321–2.365, p < 0.001). Subgroup analysis revealed a constant prognostic value of the pre-treatment CAR despite different study regions, sample size, cancer stage, treatment methods, or the cut-off value used. We also noted a correlation between high pre-treatment CAR and old age, male sex, colon cancer, advanced stage (III/IV), large tumor size, poor differentiation, elevated carcinoembryonic antigen levels, neutrophil-to-lymphocyte ratio, and the modified Glasgow prognostic score. Conclusions High pre-treatment CAR was associated with poor overall survival, disease-free survival, and progression-free survival in colorectal cancer. It can serve as a prognostic marker for colorectal cancer in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02253-y.
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Affiliation(s)
- Chun-Kai Liao
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan
| | - Yen-Lin Yu
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204, Taiwan
| | - Yueh-Chen Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan
| | - Yu-Jen Hsu
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan
| | - Yih-Jong Chern
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan
| | - Jy-Ming Chiang
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan Dist., Taoyuan, 33302, Taiwan
| | - Jeng-Fu You
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan. .,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan Dist., Taoyuan, 33302, Taiwan.
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Tamai K, Okamura S, Makino S, Yamamura N, Fukuchi N, Ebisui C, Inoue A, Yano M. C-reactive protein/albumin ratio predicts survival after curative surgery in elderly patients with colorectal cancer. Updates Surg 2021; 74:153-162. [PMID: 33677820 DOI: 10.1007/s13304-021-01011-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/20/2021] [Indexed: 02/07/2023]
Abstract
Inflammation-based markers, including the C-reactive protein/albumin ratio (CAR), lymphocyte/monocyte ratio (LMR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), Onodera's prognostic nutritional index (PNI), and Glasgow Prognostic Score (GPS), have been demonstrated to serve as prognostic indicators in various malignancies. This study aimed to evaluate their potential predictive value for colorectal cancer (CRC) in the elderly. We retrospectively evaluated 163 patients with CRC, aged 80 years and older, who had undergone curative surgery. The receiver operating characteristic curve analyses and the corresponding areas under the curve (AUCs) were used to determine and compare the discriminatory ability of the inflammation-based markers. Besides, the associations of inflammatory markers and clinical characteristics with overall survival (OS), relapse-free survival (RFS), and cancer-specific survival (CSS) were analyzed. The CAR had a significantly larger AUC than the GPS, PLR, NLR, and LMR (p = 0.006, 0.012, 0.018, and 0.002, respectively), except for the PNI (p = 0.052). The optimal cut-off value was 0.106 for the CAR and 44.894 for the PNI. Moreover, a CAR ≥ 0.106 turned out to be significantly associated with worse 5-year OS, RFS, and CSS compared with a CAR < 0.106. The multivariate analysis indicated that the CAR ≥ 0.106 was an independent prognostic factor for poor OS (HR = 3.596, p = 0.0006), RFS (HR = 2.945, p = 0.003), and CSS (HR = 4.411, p = 0.02). CAR is a useful and promising prognostic marker in elderly patients undergoing curative surgery for CRC.
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Affiliation(s)
- Koki Tamai
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Shu Okamura
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan.
| | - Shunichiro Makino
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Noriyuki Yamamura
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Nariaki Fukuchi
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Chikara Ebisui
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Akira Inoue
- Department of Gastroenterological Surgery, Osaka General Medical Center, Mandaihigashi 3-1-56, Sumiyoshi-ku, Osaka City, Osaka, 558-8558, Japan
| | - Masahiko Yano
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
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Value of C-reactive protein/albumin ratio in predicting intravenous immunoglobulin-resistant Kawasaki disease- a data from multi-institutional study in China. Int Immunopharmacol 2020; 89:107037. [DOI: 10.1016/j.intimp.2020.107037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/04/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022]
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Novel Model to Predict the Prognosis of Patients with Stage II-III Colon Cancer. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8812974. [PMID: 33299880 PMCID: PMC7704148 DOI: 10.1155/2020/8812974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/25/2020] [Accepted: 11/10/2020] [Indexed: 12/24/2022]
Abstract
Different opinions exist on the relationship between the C-reactive protein-to-albumin ratio (CAR) and the prognosis of colon cancer. This study is aimed at evaluating the relationship between CAR and prognosis of stage II–III colon cancer and establishing a clinical prognosis model. Patients were randomised to a training set (566 cases) and validation set (110 cases). The relationship between CAR and clinicopathological variables was calculated, and the Kaplan-Meier method was used to analyse the overall survival (OS) rate of colon cancer. In the training set, colon cancer independent risk factors were included in the prognosis model and then tested in the validation set. The accuracy and discrimination of the model were assessed using the C-index and calibration curves. Compared with patients with low CAR, patients with high CAR showed significantly poorer survival (P = 0.020). In the multivariate analysis, CAR, carcinoembryonic antigen (CEA), lymph node metastasis, operation mode, and perineural invasion were identified as independent prognostic indicators and adopted to establish the prediction model. The C-index of the nomogram for predicting OS reached 0.751 in the training set and 0.719 in the validation set. The calibration curve exhibited good consistency. In the present study, the CAR may be an independent prognostic factor for stage II–III colon cancer, and the nomogram has a certain predictive value. However, further prospective large-sample research needs to be conducted to validate our findings.
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Bora Makal G, Yıldırım O. Are the C-reactive protein/albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (NLR) novel inflammatory biomarkers in the early diagnosis of postoperative complications after laparoscopic sleeve gastrectomy? Obes Res Clin Pract 2020; 14:467-472. [PMID: 32807712 DOI: 10.1016/j.orcp.2020.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/21/2020] [Accepted: 07/07/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE C-reactive protein/albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are new generation inflammatory markers that have been investigated for use in determining disease prognosis or postoperative morbidity and mortality after many open surgeries. The aim of this study is to investigate the efficacy of CAR, NLR, and PLR on the early detection of postoperative complications (POC) after laparoscopic sleeve gastrectomy (LSG). MATERIAL-METHOD The study included 448 patients, 16-65 years of age, who underwent LSG between 2015 and 2019. C-reactive protein (CRP) and albumin levels were measured on postoperative day 1 and 3 and CAR values were obtained. NLR and PLR values were evaluated preoperatively and on postoperative day 1 and 3. Statistical analyses were performed using the SPSS version 21.0 and MedCalc. RESULTS A total of 326 patients with a mean age of 37 ± 11 years were analyzed. Both CAR1 and CAR3 values were correlated with the development of complications (r = 0.3, r = 0.3, respectively p < 0.001). Pre-op NLR value was found to be a significant risk factor on complication development (OR = 1.943, p = 0.043). The cut-off value for CAR1 and CAR3 were found as 0.78 and 1.25 mg/dL in ROC analysis (AUC = 0.808, AUC = 0.832, respectively). PLR3 value was diagnostic among other PLR values in the determination of POC (AUC = 0.703 Youden index = 0.36 p = 0.014). CONCLUSION The most significant diagnostic value for the determination of POC was CAR3. It was followed by CAR1, CRP3, CRP1, and PLR3 values. Only preoperative NLR was found as a risk factor for the development of POC.
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Affiliation(s)
- Gül Bora Makal
- Yuksek Ihtisas University Faculty of Medicine Department of General Surgery, Ankara, Turkey.
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Lee JW, Sharma AR, Lee SS, Chun WJ, Kim HS. The C-reactive protein to albumin ratio predicts postoperative complication in patients who undergo gastrectomy for gastric cancer. Heliyon 2020; 6:e04220. [PMID: 32577578 PMCID: PMC7303550 DOI: 10.1016/j.heliyon.2020.e04220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/29/2020] [Accepted: 06/11/2020] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to evaluate the preoperative C-reactive protein (CRP) to albumin ratio (CAR) of patients with gastric cancer and to investigate the factors correlated with perioperative complications. From March 2016 to December 2019, 128 patients who underwent curative gastrectomy for gastric cancer were enrolled in a retrospective study. The preoperative cutoff value of the CAR for predicting postoperative complications was 0.265 on receiver operating characteristic (ROC) curve analysis. Clinical characteristics were compared between patients with complications (Clavien-Dindo grade ≥2, n = 20) and without complications (Clavien-Dindo grade <2, n = 108). On univariate and multivariate analyses, estimated blood loss (EBL) during the operation (HR 1.003, p = 0.039) and CAR (HR 2.832, p = 0.045) were independent predictors of postoperative complications. In conclusion, preoperative CAR appears to be a predictor of postoperative complications in the patients undergoing surgical treatment of gastric cancer.
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Affiliation(s)
- Jin Won Lee
- Department of Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, The Hallym University, Chuncheon, Republic of Korea.,Department of Pharmacology, College of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Ashish Ranjan Sharma
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-Do, 24252, Republic of Korea
| | - Sang-Soo Lee
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-Do, 24252, Republic of Korea
| | - Wan Joo Chun
- Department of Pharmacology, College of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Hae Sung Kim
- Department of Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, The Hallym University, Chuncheon, Republic of Korea
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