Liang Yao, Xiao Wei, Guan Yuan-Xiang, Wang Wei, Chen Huo Ying, Fang Cheng, Zhang Xing, Zhou Zhi-Wei
Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, People's Republic of China.
Oncotarget. 2017 Sep 18;8(58):98135-98147. doi: 10.18632/oncotarget.20990. eCollection 2017 Nov 17.
The preoperative C-reactive protein/Albumin ratio (CAR) is valuable for predicting the prognosis of patients with various types of cancers. The aim of the present study is to investigate the prognostic value of the preoperative CAR and compare it with other systemic inflammatory response markers in patients with soft tissue sarcoma (STS).
This retrospective study included 206 patients with STS. The optimal cutoff value of the CAR was determined by receiver operating characteristic (ROC) analysis. The impact of the CAR and other clinicopathological features on overall survival (OS) and disease-free survival (DFS) was evaluated using univariate and multivariate Cox regression analyses. Kaplan-Meier survival analyses were used to compare groups classified by the CAR. Additionally, the area under the receiver operating characteristic curve (AUC) was used to compare the predictive ability of the CAR, high-sensitivity modified Glasgow prognostic score (Hs-mGPS), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR).
The optimal cut-off value of the CAR was 0.1035 according to the ROC analysis. An increased CAR (≥0.1035) was significantly associated with older age, larger tumor size, deep tumor location, higher tumor grade and more advanced American Joint Committee on Cancer (AJCC) stage (all P<0.05). Patients with an elevated CAR (≥0.1035) exhibited a shorter median survival time and lower 5-year OS rate than those with a CAR<0.1035 (68.2 vs 115.8 months, P = 0.000; 44.6% vs 80.9%, P = 0.000, respectively). The results of a multivariate analysis indicated that the CAR (Hazard ratio (HR) 2.47, 95% confidence interval (CI) 1.47-4.14, P = 0.001) was an independent prognostic factor for OS along with tumor grade (P<0.05). Additionally, the CAR exhibited a greater AUC value (0.662) than the NLR and PLR, but the value was equal to the Hs-mGPS.
The preoperative CAR is an independent prognostic factor predicting prognosis in STS and exhibits superior prognostic ability compared to the established inflammation-based prognostic indices.
术前C反应蛋白与白蛋白比值（CAR）对于预测各类癌症患者的预后具有重要价值。本研究旨在探讨术前CAR在软组织肉瘤（STS）患者中的预后价值，并将其与其他全身炎症反应标志物进行比较。
本回顾性研究纳入了206例STS患者。通过受试者工作特征（ROC）分析确定CAR的最佳截断值。采用单因素和多因素Cox回归分析评估CAR及其他临床病理特征对总生存期（OS）和无病生存期（DFS）的影响。采用Kaplan-Meier生存分析比较按CAR分类的各组。此外，利用受试者工作特征曲线下面积（AUC）比较CAR、高敏改良格拉斯哥预后评分（Hs-mGPS）、中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）的预测能力。
根据ROC分析，CAR的最佳截断值为0.1035。CAR升高（≥0.1035）与年龄较大、肿瘤体积较大、肿瘤位置较深、肿瘤分级较高以及美国癌症联合委员会（AJCC）分期较晚显著相关（均P<0.05）。CAR升高（≥0.1035）的患者中位生存时间短于CAR<0.1035的患者，5年总生存率也较低（分别为68.2个月对115.8个月，P = 0.000；44.6%对80.9%，P = 0.000）。多因素分析结果表明，CAR（风险比（HR）2.47，95%置信区间（CI）1.47 - 4.14，P = 0.001）与肿瘤分级（P<0.05）一样，是OS的独立预后因素。此外，CAR的AUC值（0.662）高于NLR和PLR，但与Hs-mGPS相等。
术前CAR是预测STS预后的独立预后因素，与已确立的基于炎症的预后指标相比，具有更好的预后预测能力。
