Liao Chun-Kai, Yu Yen-Lin, Lin Yueh-Chen, Hsu Yu-Jen, Chern Yih-Jong, Chiang Jy-Ming, You Jeng-Fu
Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan.
Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204, Taiwan.
World J Surg Oncol. 2021 May 1;19(1):139. doi: 10.1186/s12957-021-02253-y.
The inflammatory biomarker "C-reactive protein to albumin ratio (CAR)" has been reported to significantly correlate to a variety of human cancers. However, there are conflicting results regarding the prognostic value of CAR in colorectal cancer. Previous studies mainly assessed patients in Eastern countries, so their findings may not be applicable to the Western population. Therefore, this updated meta-analysis aimed to investigate the prognostic value of pre-treatment CAR and outcomes of patients with colorectal cancer.
We conducted a systematic search for eligible literature until October 31, 2020, using PubMed and Embase databases. Studies assessing pre-treatment CAR and outcomes of colorectal cancer were included. Outcome measures included overall survival, disease-free survival, progression-free survival, and clinicopathological features. The pooled hazard ratios (HR) with 95% confidence intervals (CI) were used as effective values.
A total of 15 studies involving 6329 patients were included in this study. The pooled results indicated that a high pre-treatment CAR was associated with poor overall survival (HR 2.028, 95% CI 1.808-2.275, p < 0.001) and poor disease-free survival/progression-free survival (HR 1.768, 95% CI 1.321-2.365, p < 0.001). Subgroup analysis revealed a constant prognostic value of the pre-treatment CAR despite different study regions, sample size, cancer stage, treatment methods, or the cut-off value used. We also noted a correlation between high pre-treatment CAR and old age, male sex, colon cancer, advanced stage (III/IV), large tumor size, poor differentiation, elevated carcinoembryonic antigen levels, neutrophil-to-lymphocyte ratio, and the modified Glasgow prognostic score.
High pre-treatment CAR was associated with poor overall survival, disease-free survival, and progression-free survival in colorectal cancer. It can serve as a prognostic marker for colorectal cancer in clinical practice.
炎症生物标志物“C反应蛋白与白蛋白比值（CAR）”已被报道与多种人类癌症显著相关。然而，关于CAR在结直肠癌中的预后价值存在相互矛盾的结果。先前的研究主要评估东方国家的患者，因此其研究结果可能不适用于西方人群。因此，这项更新的荟萃分析旨在研究治疗前CAR的预后价值及结直肠癌患者的预后情况。
我们使用PubMed和Embase数据库进行系统检索，直至2020年10月31日，纳入评估治疗前CAR及结直肠癌预后情况的研究。结局指标包括总生存期、无病生存期、无进展生存期及临床病理特征。采用合并风险比（HR）及95%置信区间（CI）作为有效数值。
本研究共纳入15项研究，涉及6329例患者。汇总结果表明，治疗前CAR水平较高与总生存期较差（HR 2.028，95%CI 1.808 - 2.275，p < 0.001）以及无病生存期/无进展生存期较差（HR 1.768，95%CI 1.321 - 2.365，p < 0.001）相关。亚组分析显示，无论研究地区、样本量、癌症分期、治疗方法或所使用的临界值如何，治疗前CAR均具有恒定的预后价值。我们还注意到治疗前CAR水平较高与老年、男性、结肠癌、晚期（III/IV期）、肿瘤体积较大、分化差、癌胚抗原水平升高、中性粒细胞与淋巴细胞比值以及改良格拉斯哥预后评分之间存在相关性。
治疗前CAR水平较高与结直肠癌患者的总生存期、无病生存期和无进展生存期较差相关。它可作为临床实践中结直肠癌的预后标志物。
