The prognostic value of the C-reactive protein to albumin ratio in cancer: An updated meta-analysis

Preoperative High C-Reactive Protein to Albumin Ratio Predicts Short- and Long-Term Postoperative Outcomes in Elderly Gastric Cancer Patients

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.

The clinical impact of the ratio of C-reactive protein to albumin (CAR) in patients with acute- and lymphoma-type adult T-cell leukemia-lymphoma (ATL)

Recently, the ratio of C-reactive protein to albumin (CAR) is used as an inflammatory marker that has been demonstrated to be a simple and reliable prognostic factor in solid tumors and hematological malignancy. However, no studies of the CAR have been performed in patients with adult T-cell leukemia-lymphoma (ATL). We retrospectively analyzed the clinical features and outcomes in 68 newly diagnosed acute- and lymphoma-type ATL [(acute-(n=42) or lymphoma-type (n=26)] patients in Miyazaki Prefecture from 2013 to 2017. Furthermore, we investigated correlations between pretreatment CAR levels and clinical features. The median age was 67 years (range, 44 - 87). Patients were initially treated by either palliative therapy (n=14) or chemotherapy [n=54; CHOP therapy (n=37)/ VCAP-AMP-VECP therapy (n=17)], and showed median survival durations of 0.5 months and 7.4 months, respectively. The factors affecting OS by multivariate analysis were age, BUN, and CAR. Importantly, we revealed that the high CAR group (optimal cut-off point; 0.553) was a significant indicator of worse OS by multivariate analysis (p< 0.001, HR; 5.46). The median survival of patients with a CAR< 0.553 was 8.37 months, while patients with a CAR>0.553 had a median survival of 3.94 months. The different clinical features between high CAR and low CAR groups were hypoproteinemia and the implementation of chemotherapy. Furthermore, in the chemotherapy group, but not the palliative therapy group, CAR was a significant prognostic marker. Our study indicated that CAR may be a new simple and significant independent prognostic marker in acute- and lymphoma-type ATL patients.

Pretreatment Nutritional Status in Combination with Inflammation Affects Chemotherapy Interruption in Women with Ovarian, Fallopian Tube, and Peritoneal Cancer

BACKGROUND

Discontinuing chemotherapy worsens cancer prognosis. This study aimed to investigate the relationship between nutritional status at the start of chemotherapy and chemotherapy discontinuation in patients with ovarian, fallopian tube, and primary peritoneal cancer.

METHODS

This was a retrospective cohort study. One hundred and forty-six patients to whom weekly paclitaxel and carboplatin were administered as postoperative chemotherapy were included. Six courses in 21-day cycles were defined as complete treatment. As nutritional indicators, body mass index, weight change rate, serum albumin, total lymphocyte count, prognostic nutritional index, and C-reactive protein-to-albumin ratio (CAR) were compared between complete and incomplete treatment groups. Patients were divided into two groups according to CAR. The number of chemotherapy cycles was compared between these two groups. A Cox proportional hazard model was used for covariate adjustment.

RESULTS

Several indicators differed between complete and incomplete treatment groups, and among the indicators, CAR had the highest discriminatory ability. The number of chemotherapy cycles was shorter in the high CAR group than in the low CAR group. A high CAR was associated with chemotherapy interruption even after adjusting for covariates.

CONCLUSION

Based on CAR, nutritional status before chemotherapy is suggested to be associated with the risk of chemotherapy discontinuation.

Platelet to Lymphocytes Ratio to Predict Nasopharyngeal Carcinoma Progressivity

BACKGROUND: Nasopharyngeal carcinoma (NPC) is a head and neck cancer that arises from the nasopharyngeal epithelium. It is one of the most common malignancies in Southeast Asia. In 2020, there were 133,354 new cases of NPC worldwide, with 113,659 occurring on the Asian continent (85.2%). In Indonesia, the prevalence of NPC is 6.2/100,000 people, with 13,000 new cases each year. NPC was the most frequent head and neck cancer in the Otorhinolaryngology-Head and Neck Surgery Department Dr. Hasan Sadikin Hospital Bandung from 2013 to 2018, with 921 (35.20%) new cases. AIM: Platelet-to-lymphocyte-ratio (PLR) testing has the potential to be employed as a prognostic marker in the evaluation of NPC. The purpose of this study is to investigate the link between PLR and the clinical stage of NPC. METHODS: Between 2016 and 2020, a cross-sectional study was conducted on NPC patients at Hasan Sadikin Hospital in Bandung. Patient information was gathered from the registry of the Oncology Head and Neck Surgery Study Group. Three hundred and eighty-three people met the requirements for inclusion. RESULTS: Lymph node metastases (p = 0.001), distant metastases (p = 0.001), and clinical stage (p < 0.001) are all classified differently by PLR. The platelet to lymphocytes ratio was linked to lymph node metastasis, distant metastases, and clinical stage in a statistically significant (p < 0.05). Patients with a PLR >287 have a 3.69 times chance of developing distant metastases, while those with a PLR >160 have a 1.38 times chance of progressing to the advanced stage. CONCLUSION: PLR is linked to the nasopharyngeal cancer clinical stage. Furthermore, in NPC patients, PLR can predict advanced stage and distant metastases.

Prognostic Significance of the Systemic Immune-Inflammation Index (SII) in Patients With Small Cell Lung Cancer: A Meta-Analysis

Background

Previous studies have investigated the prognostic value of the systemic immune-inflammation index (SII) in small cell lung cancer (SCLC). However, the results have been inconsistent. The study aimed to investigate the prognostic and clinicopathological significance of SII in SCLC through a meta-analysis.

Methods

The PubMed, Web of Science, Embase, Cochrane Library, and China National Knowledge Infrastructure databases were thoroughly searched. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to evaluate the prognostic value of the SII for survival outcomes. The combined odds ratios (ORs) and 95% CIs were used to evaluate the correlation between SII and clinicopathological features.

Results

Eight studies comprising 2,267 patients were included in the meta-analysis. Pooled analyses indicated that a high SII was significantly associated with worse overall survival (OS) (HR=1.52, 95% CI=1.15–2.00, p=0.003) but not progression-free survival (HR=1.38, 95% CI=0.81–2.35, p=0.238) in patients with SCLC. Moreover, a high SII was associated with extensive-stage SCLC (OR=2.43, 95% CI=1.86–3.17, p<0.001). However, there was a non-significant correlation between SII and age, sex, smoking history, Karnofsky Performance Status score, or initial therapeutic response.

Conclusion

Our meta-analysis demonstrated that a high SII could be an efficient prognostic indicator of OS in SCLC. We recommend adopting SII to predict OS in patients with SCLC, and SII in combination with other parameters or biomarkers may aid in addressing the clinical strategy and choosing the best treatment for an individual patient.

Association between Preoperative hs-crp/Albumin Ratio and Postoperative sirs in Elderly Patients: A Retrospective Observational Cohort Study

OBJECTIVES

Systemic inflammatory response syndrome (SIRS) is one of the severe postoperative complications in elderly patients and seriously affects their prognosis and survival rate. Heretofore, there have been no reliable and accurate methods to predict postoperative SIRS in elderly patients. The aim of this study was to determine whether increased preoperative hs-CRP/albumin ratio (CAR) was associated with postoperative SIRS in elderly population.

METHODS

The data of patients aged ≥ 65 years who underwent general anesthesia in two centers of Third Affiliated Hospital of Sun Yat-sen University between January 2015 and September 2020 were retrieved and analyzed. Based on the perioperative dataset, we used the targeted maximum likelihood estimation (TMLE) to estimate the association between preoperative CAR and postoperative SIRS in elderly population. Patients' CAR was calculated and divided into two groups (< 0.278 and ≥ 0.278) according to its normal range in our hospital. Adjusted odd ratios (aORs) and 95% confidence intervals (CIs) were calculated respectively. Further sensitivity analyses were conducted to evaluate the robustness of the results.

RESULTS

A total of 16141 elderly patients were accessed and 7009 of them were enrolled in the final analysis, and 1674 (23.9%) patients developed SIRS within 3 days after surgery. Compared with non-SIRS patients, patients with SIRS had a significantly longer postoperative hospitalization, higher cost and higher risk of in-hospital mortality. Compared with patients with preoperative CAR < 0.278, we found that CAR ≥ 0.278 had a significantly higher risk for the development of postoperative SIRS after multivariable adjustment [aOR = 1.27; 95% CI (1.21, 1.33)]. The interaction effect of preoperative CAR ≥ 0.278 and SIRS was stronger among patients with the following characteristics: aged ≥ 75 years, male, comorbid with diabetes mellitus and admitted to ICU after surgery, duration of surgery < 120 minutes, underwent cerebral surgery or skin, spine and joint surgery (all P < 0.001). The above results remained robust in the sensitivity analysis.

CONCLUSIONS

Preoperative CAR ≥ 0.278 was significantly associated with increased risk of postoperative SIRS in elderly patients. Special attention should be paid to elderly patients with a preoperative CAR ≥ 0.278 so as to reduce the incidence of postoperative SIRS.

Prognostic Value of Prospective Longitudinal CRP to Albumin Ratio among Older Outpatients with Cancer

Simple Summary

The prognostic value of the C-reactive protein to albumin ratio (CAR) among older adults with cancer is not known. As an inflammation and nutrition-based score, the CAR could be used as a biomarker of cancer-cachexia. We aimed to assess the prognostic value of longitudinal trajectories of the CAR on overall survival among older adults with cancer. By identifying two distinct clusters in the longitudinal trajectories of the CAR with significantly different overall survivals, we were able to characterize older patients with cancer which are the most at-risk to have a cancer-cachexia trajectory. For these patients (typically the most frail with a metastatic cancer), we suggest an early assessment of muscle mass in order to start a multimodal rehabilitation as soon as possible.

Abstract

The prognostic value of the CRP to albumin ratio (CAR) among older adults with cancer is not known. Six hundred and three older outpatients with cancer and undergoing geriatric assessment before therapeutic decisions were prospectively recruited from the PF-EC cohort study. Serum albumin levels, serum CRP levels and the CAR were prospectively recorded at baseline, and at each consultation thereafter, as follows: 1, 3, 6, 9, 12, 18, 24 and 36 months. Frailty was defined as a G8-index ≤ 14. The primary endpoint was longitudinal variation in the CAR during the study follow-up. Two clusters in the longitudinal trajectories of the CAR were identified, one favourable, with lower values and better overall survival (cluster A), and the second with higher values and less favourable overall survival (cluster B). The median CAR [95% CI] for clusters A and B were respectively: 0.17 [0.04–0.48] and 0.26 [0.04–0.79] at baseline (p = 0.01), and 0.18 [0.02–3.17] and 0.76 [0.03–6.87] during the study follow-up (p < 0.0001). Cluster B was associated with the frailest patients with metastatic disease, mainly driven by a high CRP level at baseline, and low albumin during the study follow-up. Our study results suggest that the most risk-prone patients have a cancer-cachexia trajectory.

Preoperative Serum Hypersensitive-c-Reactive-Protein (Hs-CRP) to Albumin Ratio Predicts Survival in Patients with Luminal B Subtype Breast Cancer

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.

Clinical value and limitations of the preoperative C-reactive-protein-to-albumin ratio in predicting post-operative morbidity and mortality after deceased-donor liver transplantation: a retrospective single-centre study

Liver transplantation is still associated with a high risk of severe complications and post-operative mortality. This study examines the predictive value of the preoperative C-reactive-protein-to-albumin ratio (CAR) regarding perioperative morbidity and mortality in deceased-donor liver transplantation (DDLT) recipients. In total, 390 DDLT recipients between 05/2010 and 03/2020 were eligible. Predictive abilities of CAR were examined through receiver operating characteristic curve (ROC) analyses. Groups were compared using parametric and non-parametric tests as appropriate. Independent risk factors for morbidity and mortality were identified using uni- and multivariable logistic regression analyses. A good predictive ability for CAR was shown regarding perioperative morbidity (comprehensive complication index ≥75, Clavien-Dindo score ≥4a) and 12-month mortality, with an ideal cut-off of CAR = 26%. Patients with CAR>26% had significantly higher median CCI scores (60 vs. 43, P < 0.001), longer intensive care unit (ICU, 5 vs. 4 days, P < 0.001) and hospital (28 vs. 21 days, P < 0.001) stays and higher 12-month mortality rates (20% vs 6%, P < 0.001). Multivariable analyses identified CAR>26%, pre-OLT inpatient hospitalization (including ICU) and post-operative red blood cell transfusions as independent predictors of severe cumulative morbidity (CCI≥75). Preoperative CAR might be a reliable additional tool to predict perioperative morbidity and mortality in DDLT recipients.

Prognostic value of C-reactive protein to albumin ratio in patients resuscitated from out-of-hospital cardiac arrest

BACKGROUND

Despite major advances in basic and advanced life supports, patients who survived from out-of-hospital cardiac arrest (OHCA) have still poor prognosis. Several inflammatory parameters have been used to determine early and long-term prognosis in patients with OHCA. C-reactive protein-to-albumin ratio (CAR) is also a novel marker of systemic inflammation. To our knowledge, there is no study evaluating the clinical importance of CAR in OHCA patients.

AIMS

To evaluate the effect of CAR on in-hospital mortality in patients with OHCA.

METHODS

A total of 102 patients with OHCA were included in this study. The study population was divided into two groups as survivour (n = 43) and non-survivour (n = 59) during follow-up. Complete blood cell counts, biochemical and blood gas analyses were recorded for all patients. Neutrophil to lymphocyte ratio (NLR) was calculated as the ratio of neutrophil to lymphocyte. CAR was calculated as the ratio of C-reactive protein to the albumin.

RESULTS

NLR (P = .012), CAR (P < .001) and serum lactate level (P = .002) were significantly higher whereas lymphocyte (P = .008) and serum albumin (P < .001) were significantly lower in the non-survivour group compared with the survivour group. Multivariate logistic regression analysis showed that NLR (odds ratio [OR]: 1.044, 95% confidence interval [CI]: 1.044-1.437, P = .013), CAR (OR: 1.971, 95% CI: 1.327-2.930, P = .001) and lactate level (OR: 1.268, 95% CI: 1.095-1.469, P = .002) were independent predictors of in-hospital mortality.

CONCLUSIONS

We have demonstrated for the first time that CAR was an independent predictor of in-hospital mortality in OHCA patients.

Prognostic Value of C-Reactive Protein to Albumin Ratio in Gastric Cancer: A Meta-Analysis

OBJECTIVE

C-reactive protein to albumin ratio (CRP/Alb) is investigated as a prognostic marker in gastric cancer in previous studies, with presence of inconsistent data. Therefore, this study aimed to explore the prognostic role of CRP/Alb in gastric cancer through meta-analysis.

METHODS

This meta-analysis systemically retrieved PubMed, Embase, Web of Science, the Chinese National Knowledge Infrastructure (CNKI), and Wanfang up to July 4, 2020. Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were conducted to evaluate the association between CRP/Alb and survival outcomes.

RESULTS

A total of nine studies with 3346 patients were included in the present meta-analysis. The pooled HR and 95%CI were: HR = 1.89, 95%CI = 1.64-2.19, p < 0.001 for overall survival (OS) and HR = 2.15, 95%CI = 1.72-2.70, p < 0.001 for disease-free survival (DFS). Subgroup analysis demonstrate that an elevated CRP/Alb remain a significant prognostic factor for poor OS and DFS irrespective of sample size, nationality of patients, or cutoff value resource (p < 0.05 in all subgroups).

CONCLUSIONS

The present meta-analysis suggests that high CRP/Alb is predictive of poor OS and DFS in gastric cancer. CRP/Alb is therefore a potential prognostic factor in the management of patients with gastric cancer.

Pretreatment C-reactive protein/albumin ratio for predicting overall survival in pancreatic cancer: A meta-analysis

BACKGROUND

Inconsistent findings have been reported regarding the association of C-reactive protein to albumin ratio (CAR) with survival outcome in patients with pancreatic cancer. We conducted the current meta-analysis to assess the prognostic utility of elevated baseline CAR in predicting overall survival (OS) in pancreatic cancer patients.

METHODS

A comprehensively literature search was performed in the PubMed and Embase database until February 10, 2019. Studies evaluating the association between pretreatment CAR and OS among pancreatic cancer were selected. Study quality was evaluated by using the Newcastle-Ottawa Scale.

RESULTS

Nine retrospective studies involving 1534 pancreatic cancer patients were identified. A meta-analysis using a random-effect model indicated that elevated CAR was associated with poor OS (hazard ratio 1.98; 95% confidence interval 1.58-2.48). Subgroup analysis produced similar prognostic values for OS in different geographical regions, sample sizes, thresholds of CAR, treating methods, and Newcastle-Ottawa Scale points.

CONCLUSION

Elevated pretreatment CAR may independently predict poor OS in pancreatic cancer patients. Pretreatment CAR is possibly a simple and cost-effective blood-derived indicator for predicting survival outcome in patients with pancreatic cancer.