Shibutani Masatsune, Maeda Kiyoshi, Nagahara Hisashi, Iseki Yasuhito, Ikeya Tetsuro, Hirakawa Kosei
Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka City, Osaka, Japan
Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka City, Osaka, Japan.
Anticancer Res. 2016 Mar;36(3):995-1001.
BACKGROUND: Inflammation has been reported to play an important role in cancer progression, and several inflammatory markers, such as the neutrophil to lymphocyte ratio (NLR) and modified Glasgow prognostic score (mGPS), have been reported to be prognostic markers. The aim of this retrospective study was to evaluate the prognostic significance of the ratio of C-reactive protein to albumin (CRP/ALB ratio) in patients with colorectal cancer who undergo potentially curative surgery. PATIENTS AND METHODS: A total of 705 patients who underwent potentially curative surgery for colorectal cancer were enrolled. The CRP/ALB ratio was calculated form the preoperative samples by dividing the serum C-reactive protein level by the serum albumin level. We evaluated the correlation between the CRP/ALB ratio and survival. Furthermore, we compared the accuracy of the CRP/ALB ratio as a predictor for survival with the mGPS. RESULTS: We set 0.0271 as the cut-off value for the CRP/ALB ratio according to a receiver operating characteristic curve analysis. Based on the cut-off value of 0.0271, 347 patients were classified into the low CRP/ALB ratio group and 358 patients were classified into the high CRP/ALB ratio group. The group with high CRP/ALB ratio had significantly worse relapse-free survival (p=0.0003) and cancer-specific survival (p=0.0026) rates than those of the low CRP/ALB ratio group. According to a multivariate analysis, the CRP/ALB ratio was identified as an independent prognostic factor for relapse-free survival (p=0.025) and cancer-specific survival (p=0.045). Moreover, even in a sub-analysis limited to patients with an mGPS of 0, the high CRP/ALB ratio group had significantly worse relapse-free survival (p=0.0015) and cancer-specific survival (p=0.0131) rates than the low CRP/ALB ratio group. CONCLUSION: The preoperative CRP/ALB ratio is a useful prognostic marker in patients with colorectal cancer who undergo potentially curative surgery. Moreover, the CRP/ALB ratio may be superior to the mGPS for predicting survival.
背景：炎症在癌症进展中发挥重要作用，据报道，中性粒细胞与淋巴细胞比值（NLR）和改良格拉斯哥预后评分（mGPS）等几种炎症标志物是预后标志物。本回顾性研究的目的是评估C反应蛋白与白蛋白比值（CRP/ALB比值）对接受根治性手术的结直肠癌患者的预后意义。 患者与方法：共纳入705例接受结直肠癌根治性手术的患者。CRP/ALB比值通过术前样本中血清C反应蛋白水平除以血清白蛋白水平计算得出。我们评估了CRP/ALB比值与生存率之间的相关性。此外，我们将CRP/ALB比值作为生存预测指标的准确性与mGPS进行了比较。 结果：根据受试者工作特征曲线分析，我们将CRP/ALB比值的临界值设定为0.0271。基于0.0271的临界值，347例患者被分为低CRP/ALB比值组，358例患者被分为高CRP/ALB比值组。高CRP/ALB比值组的无复发生存率（p=0.0003）和癌症特异性生存率（p=0.0026）明显低于低CRP/ALB比值组。多因素分析显示，CRP/ALB比值是无复发生存（p=0.025）和癌症特异性生存（p=0.045）的独立预后因素。此外，即使在仅限于mGPS为0的患者的亚分析中，高CRP/ALB比值组的无复发生存率（p=0.0015）和癌症特异性生存率（p=0.0131）也明显低于低CRP/ALB比值组。 结论：术前CRP/ALB比值是接受根治性手术的结直肠癌患者有用的预后标志物。此外，CRP/ALB比值在预测生存方面可能优于mGPS。
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