Wei Xiao-li, Wang Feng-hua, Zhang Dong-sheng, Qiu Miao-zhen, Ren Chao, Jin Ying, Zhou Yi-xin, Wang De-shen, He Ming-ming, Bai Long, Wang Feng, Luo Hui-yan, Li Yu-hong, Xu Rui-hua
Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, Guangdong Province, China.
BMC Cancer. 2015 May 2;15:350. doi: 10.1186/s12885-015-1379-6.
Plenty of studies have demonstrated the prognostic value of various inflammation-based indexes in cancer. This study was designed to investigate the prognostic value of the C-reactive protein/albumin (CRP/Alb) ratio in esophageal squamous cell carcinoma.
A retrospective study of 423 cases with newly diagnosed esophageal squamous cell carcinoma was conducted. We analyzed the association of the CRP/Alb ratio with clinicopathologic characteristics. The prognostic value was explored by univariate and multivariate survival analysis. In addition, we compared the discriminatory ability of the CRP/Alb ratio with other inflammation-based prognostic scores by evaluating the area under the receiver operating characteristics curves (AUC), including the modified Glasgow Prognostic Score (mGPS), neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR).
The optimal cut-off value was identified to be 0.095 for the CRP/Alb ratio. A higher level of the CRP/Alb ratio was associated with larger tumor size (P < 0.001), poorer differentiation (P = 0.019), deeper tumor invasion (P = 0.003), more lymph node metastasis (P = 0.015), more distant metastasis (P < .001) and later TNM stage (P < 0.001). The CRP/Alb ratio was identified to be the only inflammation-based prognostic score with independent association with overall survival by multivariate analysis (P = 0.031). The AUC value of the CRP/Alb ratio was higher compared with the NLR and PLR, but not mGPS at 6, 12 and 24 months of follow-up. In addition, the CRP/Alb ratio could identify a group of patients with mGPS score of 0 who had comparable overall survival with those with mGPS score of 1.
The CRP/Alb ratio is a novel but promising inflammation-based prognostic score in esophageal squamous cell carcinoma. It is a valuable coadjutant for the mGPS to further identify patients' survival differences.
大量研究已证实各种基于炎症的指标在癌症中的预后价值。本研究旨在探讨C反应蛋白/白蛋白（CRP/Alb）比值在食管鳞状细胞癌中的预后价值。
对423例新诊断的食管鳞状细胞癌患者进行回顾性研究。我们分析了CRP/Alb比值与临床病理特征的相关性。通过单因素和多因素生存分析探讨其预后价值。此外，我们通过评估受试者工作特征曲线（AUC）下面积，比较了CRP/Alb比值与其他基于炎症的预后评分的鉴别能力，包括改良格拉斯哥预后评分（mGPS）、中性粒细胞淋巴细胞比值（NLR）和血小板淋巴细胞比值（PLR）。
CRP/Alb比值的最佳截断值确定为0.095。CRP/Alb比值较高与肿瘤体积较大（P < 0.001）、分化较差（P = 0.019）、肿瘤浸润较深（P = 0.003）、更多淋巴结转移（P = 0.015）、更多远处转移（P < 0.001）及更晚的TNM分期（P < 0.001）相关。多因素分析确定CRP/Alb比值是唯一与总生存独立相关的基于炎症的预后评分（P = 0.031）。在随访6、12和24个月时，CRP/Alb比值的AUC值高于NLR和PLR，但不高于mGPS。此外，CRP/Alb比值可识别出一组mGPS评分为0但总生存与mGPS评分为1的患者相当的患者。
CRP/Alb比值是食管鳞状细胞癌中一种新的但有前景的基于炎症的预后评分。它是mGPS进一步识别患者生存差异的有价值辅助指标。
