Burgassi Fiamma, Paillaud Elena, Poisson Johanne, Bousquet Guilhem, Pamoukdjian Frédéric
Service de Médecine Gériatrique, Hôpital Avicenne, APHP, 93000 Bobigny, France.
Service de Gériatrie, Hôpital Européen Georges Pompidou, APHP, 75015 Paris, France.
Cancers (Basel). 2021 Nov 18;13(22):5782. doi: 10.3390/cancers13225782.
The prognostic value of the CRP to albumin ratio (CAR) among older adults with cancer is not known. Six hundred and three older outpatients with cancer and undergoing geriatric assessment before therapeutic decisions were prospectively recruited from the PF-EC cohort study. Serum albumin levels, serum CRP levels and the CAR were prospectively recorded at baseline, and at each consultation thereafter, as follows: 1, 3, 6, 9, 12, 18, 24 and 36 months. Frailty was defined as a G8-index ≤ 14. The primary endpoint was longitudinal variation in the CAR during the study follow-up. Two clusters in the longitudinal trajectories of the CAR were identified, one favourable, with lower values and better overall survival (cluster A), and the second with higher values and less favourable overall survival (cluster B). The median CAR [95% CI] for clusters A and B were respectively: 0.17 [0.04-0.48] and 0.26 [0.04-0.79] at baseline ( = 0.01), and 0.18 [0.02-3.17] and 0.76 [0.03-6.87] during the study follow-up ( < 0.0001). Cluster B was associated with the frailest patients with metastatic disease, mainly driven by a high CRP level at baseline, and low albumin during the study follow-up. Our study results suggest that the most risk-prone patients have a cancer-cachexia trajectory.
癌症老年患者中C反应蛋白与白蛋白比值（CAR）的预后价值尚不清楚。从PF-EC队列研究中前瞻性招募了603名癌症老年门诊患者，这些患者在进行治疗决策前接受了老年评估。前瞻性记录了基线时以及此后每次会诊时（分别为1、3、6、9、12、18、24和36个月）的血清白蛋白水平、血清C反应蛋白水平和CAR。衰弱定义为G8指数≤14。主要终点是研究随访期间CAR的纵向变化。确定了CAR纵向轨迹中的两个聚类，一个是有利的，值较低且总生存期较好（聚类A），另一个值较高且总生存期较差（聚类B）。聚类A和B在基线时的CAR中位数[95%CI]分别为：0.17[0.04 - 0.48]和0.26[0.04 - 0.79]（P = 0.01），在研究随访期间分别为0.18[0.02 - 3.17]和0.76[0.03 - 6.87]（P < 0.0001）。聚类B与患有转移性疾病的最衰弱患者相关，主要由基线时的高C反应蛋白水平和研究随访期间的低白蛋白水平驱动。我们的研究结果表明，最易发生风险的患者具有癌症恶病质轨迹。
