Ishizuka Mitsuru, Nagata Hitoshi, Takagi Kazutoshi, Iwasaki Yoshimi, Shibuya Norisuke, Kubota Keiichi
Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.
Ann Surg Oncol. 2016 Mar;23(3):900-7. doi: 10.1245/s10434-015-4948-7. Epub 2015 Nov 3.
This study was designed to estimate the clinical significance of the C-reactive protein (CRP)/albumin ratio (CAR) for prediction of postoperative survival in patients with colorectal cancer (CRC).
The Glasgow Prognostic Score (GPS), calculated from the serum levels of CRP and albumin, is well known to be a valuable inflammation-based prognostic system for several types of cancer. A recent study has demonstrated that the CAR is also useful for prediction of treatment outcome in patients with hepatocellular carcinoma.
Uni- and multivariate analyses using the Cox proportional hazards model were performed to detect the clinical characteristics that were most closely associated with overall survival (OS). All recommended cutoff values were defined using receiver operating characteristic curve analyses. Kaplan-Meier analysis was used to compare OS curves between the two groups.
A total of 627 patients who had undergone elective CRC surgery were enrolled. Multivariate analysis using the results of univariate analyses demonstrated that CAR (>0.038/≤0.038) was associated with OS (hazard ratio 2.596; 95% confidence interval 1.603-4.204; P < 0.001) along with pathological differentiation (others/well or moderately), carcinoembryonic antigen level (>8.7/≤8.7, ng/ml), stage (III, IV/0, I, II), neutrophil to lymphocyte ratio (NLR) (>2.9/≤2.9), and GPS (2/0, 1). Kaplan-Meier analysis and log rank test demonstrated a significant difference in OS curves between patients with low CAR (≤0.038) and those with high CAR (>0.038; P < 0.001).
CAR is as useful for predicting the postoperative survival of patients with CRC as previously reported inflammation-based prognostic systems, such as GPS and NLR.
本研究旨在评估C反应蛋白（CRP）/白蛋白比值（CAR）对预测结直肠癌（CRC）患者术后生存的临床意义。
根据血清CRP和白蛋白水平计算得出的格拉斯哥预后评分（GPS），是一种广为人知的、对多种癌症有价值的基于炎症的预后系统。最近一项研究表明，CAR对预测肝细胞癌患者的治疗结果也有用。
采用Cox比例风险模型进行单因素和多因素分析，以检测与总生存（OS）最密切相关的临床特征。所有推荐的临界值均通过受试者工作特征曲线分析来定义。采用Kaplan-Meier分析比较两组的OS曲线。
共纳入627例行择期CRC手术的患者。单因素分析结果进行的多因素分析表明，CAR（>0.038/≤0.038）与OS相关（风险比2.596；95%置信区间1.603 - 4.204；P < 0.001），此外还与病理分化（其他/高分化或中分化）、癌胚抗原水平（>8.7/≤8.7，ng/ml）、分期（III、IV/0、I、II）、中性粒细胞与淋巴细胞比值（NLR）（>2.9/≤2.9）以及GPS（2/0、1）相关。Kaplan-Meier分析和对数秩检验表明，低CAR（≤0.038）患者与高CAR（>0.038）患者的OS曲线存在显著差异（P < 0.001）。
CAR在预测CRC患者术后生存方面与先前报道的基于炎症的预后系统（如GPS和NLR）同样有用。
