Cui Xinhua, Jia Zhiqiang, Chen Dingchao, Xu Chunwei, Yang Peng
Department of General Surgery, Zhejiang Rongjun Hospital, Jiaxing City, Zhejiang Province, China.
Medicine (Baltimore). 2020 Apr;99(14):e19165. doi: 10.1097/MD.0000000000019165.
Previous studies have demonstrated that the C-reactive protein to albumin ratio (CAR) is correlated with the clinical outcomes of solid tumors. However, the available data have not been systematically evaluated. The objective of the present meta-analysis was to explore the prognostic value of the CAR in solid tumors.
Eligible studies were identified from the PubMed, EMBASE and Web of Science electronic databases. The clinical characteristics, disease -free survival (DFS) /progression-free survival (PFS) and overall survival (OS) were extracted from the eligible studies. The pooled hazard ratios (HRs) and 95% confidence intervals were calculated with STATA 12.0 software. We also performed subgroup, meta-regression and sensitivity analyses.
In total, twenty-seven eligible studies including 10556 patients were enrolled in the present meta-analysis. The pooled HRs with 95% confidence intervals showed that the CAR was significantly associated with poor OS (HR = 1.95, 95% CI: 1.71-2.22) and DFS/PFS (HR = 1.82, 95% CI: 1.61-2.07) in patients with solid tumors. Although publication bias was found in the studies with regard to OS, a further trim and fill analysis revealed that the adjusted HR was 1.82 (95% CI: 1.69-1.96), which was close to the original HR. Subgroup analysis confirmed the CAR as a strong prognostic marker in patients with solid tumors, regardless of the tumor type, detection time, cut-off value, sample size and area.
Our meta-analysis indicated that a high CAR might be an unfavorable prognostic marker for OS and DFS/PFS in patients with solid tumors.
既往研究表明，C反应蛋白与白蛋白比值（CAR）与实体瘤的临床结局相关。然而，现有数据尚未得到系统评估。本荟萃分析的目的是探讨CAR在实体瘤中的预后价值。
从PubMed、EMBASE和Web of Science电子数据库中检索符合条件的研究。从符合条件的研究中提取临床特征、无病生存期（DFS）/无进展生存期（PFS）和总生存期（OS）。使用STATA 12.0软件计算合并风险比（HR）和95%置信区间。我们还进行了亚组分析、meta回归分析和敏感性分析。
本荟萃分析共纳入27项符合条件的研究，包括10556例患者。合并的HR及95%置信区间显示，CAR与实体瘤患者的不良OS（HR = 1.95，95% CI：1.71 - 2.22）和DFS/PFS（HR = 1.82，95% CI：1.61 - 2.07）显著相关。尽管在OS相关研究中发现了发表偏倚，但进一步的修剪填充分析显示，调整后的HR为1.82（95% CI：1.69 - 1.96），与原始HR接近。亚组分析证实，无论肿瘤类型、检测时间、截断值、样本量和地区如何，CAR都是实体瘤患者强有力的预后标志物。
我们的荟萃分析表明，高CAR可能是实体瘤患者OS和DFS/PFS的不良预后标志物。
